Treatment with 311-nm ultraviolet B accelerates and improves the clearance of psoriatic lesions in patients treated with etanercept

Authors


  • Conflicts of interest
    The Research Unit for Photodermatology, Medical University of Graz, has been supported by a grant from Wyeth Lederle Pharma GmbH Austria. This grant was intended to promote general research in the field of photoimmunology, phototherapy and biologics, and was not restricted to specific projects. P.W. holds a professorship for Bioimmunotherapy at the Medical University of Graz, supported by a donation from Wyeth Lederle.

Peter Wolf.
E-mail: peter.wolf@meduni-graz.at

Summary

Background  Some patients with plaque-type psoriasis respond slowly to treatment with etanercept. In such cases combining etanercept with conventional treatments might be helpful.

Objectives  To investigate whether treatment with 311-nm ultraviolet (UV) B can improve the therapeutic response in patients treated with etanercept.

Methods  Four women and one man (mean age 57 years, range 48–66) with moderate to severe plaque-type psoriasis who had received standard treatment with etanercept 50 mg twice weekly for 6 weeks without Psoriasis Area and Severity Index (PASI) reduction of 75% or greater (of initial mean PASI of 16·0, range 15·4–20·4) were enrolled in the study. Starting at 6 weeks, 311-nm UVB treatment was given to a randomly selected body half (left or right, excluding the head) for another 6 weeks, while all patients continued receiving etanercept. The patients were monitored by half-body PASI at weekly intervals.

Results  During the 6-week irradiation regimen, 311-nm UVB significantly bolstered the therapeutic response in the patients on etanercept treatment. After 6 weeks of 311-nm UVB, the patients had a mean PASI on their UV-irradiated body halves of 1·6 (range 0·6–3·3) vs. 4·7 (range 1·4–8·6) on nonirradiated body halves (= 0·0192, paired two-tailed t-test), compared with 10·7 (range 6–16·4) and 10·5 (range 5·2–16·4) at start of 311-nm UVB treatment. The overall mean PASI reduction from baseline (i.e. at etanercept start) was 89% vs. 68%, respectively (= 0·0009 and = 0·0088).

Conclusions  Treatment with 311-nm UVB significantly accelerates and improves the clearance of psoriatic lesions in patients responding slowly to etanercept monotherapy.

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