For the treatment of psoriasis, phototherapy is the leader in both effectiveness and speed of clearance. Narrowband UVB and PUVA (Psoralen + UVA) are safe, work extremely well, and are twice as fast at clearing patients with moderate to severe psoriasis.
PUVA (Psoralen + UVA): 90%3
Daavlin Narrowband UVB: 82%9
Remicade® (Infliximab): 80%8
Humira® (Adalimumab): 62%7
Enbrel® (Etanercept): 47%-49%5
Raptiva®(Efalizumab): 32%6 (Removed from market 06/09 due to severe side effects)
From this quick comparison it is obvious that only Remicade® (Infliximab) approaches the clearance rates of phototherapy. Besides it’s high cost, nearly $20,000 per patient per year, Infliximab has a lengthy list of side effects and typically takes several months of treatment to show results.
Median Time to Reach Clearance:
PUVA (Psoralen+UVA): 4 weeks4
Narrowband UVB: 5 weeks3
Remicade® (Infliximab): 8 weeks8
Humira® (Adalimumab): 8 weeks7
Enbrel® (Etanercept): 8 weeks5
Raptiva®(Efalizumab):10 weeks6 (Removed from market 6/09 due to severe side effects)
From the raw data above, it should be apparent that not only is phototherapy more effective than competing biological drugs, it works nearly twice as fast. In addition, of the biologics, only Enbrel® (Etanercept) is approved for pediatric use in the treatment of psoriasis. In comparison, Narrowband phototherapy is approved and has a long track record of safe pediatric use.
When evaluating the effectiveness of phototherapy, literature reports clearance1 rates as high as 94% for PUVA2, though most PUVA studies show clearance rates closer to 90%. For Narrowband UVB phototherapy using Philips /01 lamps, literature shows slightly less effectiveness3 than PUVA, with a clearance rate typically in the 70% to 80% range.
However, using Daavlin equipment and Daavlin’s suggested MED-based protocols, clinical studies have consistently shown even better results with an 82% clearance rate.9 When used with topical drugs, phototherapy combination treatments are even more effective, with reports of up to a 93% clearance rate with a Narrowband UVB + Etretinate combination. The bottom line: Daavlin Phototherapy works faster and better for your patients.
1 Promotional literature can be a confusing mix of different numbers when trying to compare the effectiveness of psoriasis treatments. Some studies use the PASI (Psoriasis Area and Severity Index ) system, while others use a physician assessment of clearance (sPGA) or disease resolution. In the studies that use both metrics, psoriasis clearance is considered to be at least a 75% decrease in PASI score. Since few practitioners use the PASI analysis clinically, clearance rate (sPGA) seems like a more useful comparison tool.
2 Comparison of clinical efficacy and cost effectiveness of psoralen plus ultraviolet A light phototherapy (PUVA) versus PUVA plus sunlight (PUVASOL) therapy in chronic plaque psoriasis in Indian patients Journal of the American Academy of Dermatology, Volume 60, Issue 3, Pages AB153-AB153
3 Palmer, et al. Photoadaptation during Narrowband Ultraviolet-B Therapy Is Independent of Skin Type: A Study of 352 Patients Journal of Investigative Dermatology (2006) 126, 1256–1263
4 Yones, et al. Randomized double-blind trial of the treatment of chronic plaque psoriasis: efficacy of psoralen-UV-A therapy vs narrowband UV-B therapy. Arch Dermatol. 2006 Jul;142(7):836-42.
5 ENBREL® Physician Package Insert. Available at: http://www.enbrel.com/pdf/enbrel_pi.pdf
6 RAPTIVA® Prescribing Information. Available at: http://www.gene.com/gene/products/information/pdf/raptiva-prescribing.pdf
7 HUMIRA® Prescribing Information. Available at: http://www.rxabbott.com/pdf/humira.pdf
8 REMICADE® Prescribing Information. Available at: http://www.remicade.com/remicade/assets/HCP_PPI.pdf
9Suberythemogenic narrow-band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris, Walters, et al. Journal of the American Academy of Dermatology, Volume 40, Issue 6, June 1999, Pages 893-900