Fumaric acid esters in combination with a 6-week course of narrowband ultraviolet B provides an accelerated response compared with fumaric acid esters monotherapy in patients with moderate-to-severe plaque psoriasis: a randomized prospective clinical study

BackgroundFumaric acid esters (FAE) are safe and effective in patients with moderate-to-severe psoriasis but have a slow onset of action. A short-term combination with narrowband ultraviolet B (NB-UVB) may substantially accelerate the therapeutic response in the induction phase of treatment. ObjectivesTo assess the synergistic effect of a 6-week course of NB-UVB phototherapy in addition to FAE in adults with moderate-to-severe plaque psoriasis. MethodsIn this randomized, assessor-masked trial, patients with a Psoriasis Area and Severity Index (PASI) of 10 and a body surface area affected of 10 were randomized either to monotherapy with FAE (n = 16) or a combination of FAE with NB-UVB (n = 14). The primary outcome parameter of the study was the mean PASI reduction after 6 weeks of treatment. In addition, the PASI 75 response ( 75% improvement from baseline PASI), the Psoriasis Log-based Area and Severity Index (PLASI) and the Dermatology Life Quality Index (DLQI) were assessed as secondary outcome measures. ResultsIn total, 30 patients (19 men, 11 women; median age 52 years, interquartile range 36-56) were analysed. The mean reduction in PASI after 6 weeks was significantly greater with the combination treatment than with FAE monotherapy (P = 0016). This was paralleled by a much faster improvement in the DLQI in the combination group than in the FAE-monotherapy group. ConclusionsAdding a 6-week course of NB-UVB to FAE both accelerates and augments the therapeutic response during the early phase of treatment and increases quality of life in patients with moderate-to-severe plaque psoriasis. What's already known about this topic? Fumaric acid esters (FAE) are an effective and safe systemic treatment option for psoriasis but have a slow onset of action. Narrowband ultraviolet B (NB-UVB) phototherapy results in rapid improvement or clearing of psoriasis but is not suitable for maintenance treatment. What does this study add? The combination of FAE with a short initial 6-week course of NB-UVB provides an accelerated and enhanced clinical response during the early phase of treatment. This is paralleled by a faster improvement in the patients' quality of life. Linked Comment:Bouwes Bavinck and van Zuuren. Br J Dermatol 2018; 178:586-587. Plain language summary available online Respond to this article