Home- versus hospital-based phototherapy for vitiligo is associated with significantly improved adherence to phototherapy treatments, but patients were more likely to experience severe treatment-related adverse events (TRAE), according to Stuart Neil Cohen, BMedSci (Hons), MMedSci (Clin Ed), FRCP.
“Phototherapy has been shown to have a positive effect on vitiligo, especially in conjunction with other treatments,” Dr. Cohen wrote. “However, treatment requires frequent, regular hospital visits for at least several months, so it is not undertaken often.” For a study published in Photo dermatology, Photo immunology & Photomedicine, Dr. Cohen and colleagues conducted a systematic review and meta-analysis to assess the efficacy and safety of home-based phototherapy for vitiligo to determine if it is a viable alternative to institution-based phototherapy.
Three RCTs Were Included in the Study
Dr. Cohen and colleagues included three randomized controlled trials (RCTs) that collectively included 195 participants aged 5-71. Two RCTs compared home-based phototherapy with institution-based phototherapy: an RCT by Guan and colleagues that included 44 patients with stable focal vitiligo treated with home-based phototherapy via the Daavlin Dermapal system or institution-based phototherapy administered via an excimer lamp, and an RCT by Liu and colleagues consisting of 122 patients with new-onset vitiligo with 5% or less body surface area (BSA) involvement treated with phototherapy via the Sigma SH1b hand-held narrowband ultraviolet B unit, either self-administered at home or by staff in a hospital setting. The third RCT, which was conducted by Eleftheriadou and colleagues, compared phototherapy with a Dermfix 1000 or Waldmann device with placebo in 29 patients with nonsegmental spreading or stable vitiligo affecting less than 25% of BSA. Each of the RCTs was assessed for multiple safety and efficacy factors, such as repigmentation rates, QOL, TRAEs, and treatment adherence.
Repigmentation Rates, QOL Were Assessed in Each Trial
Although regimens varied between studies, in the two studies comparing home- and institution-based phototherapy, repigmentation rates were similar between phototherapy arms in both studies. In the RCT by Guan and colleagues,
approximately half of patients in the homebased phototherapy arm and one-third in the institution-based phototherapy arm experienced lesion repigmentation greater than 75%, whereas in the RCT by Liu and colleagues, approximately half of patients in each treatment arm experienced lesion repigmentation greater than 75%.
Repigmentation rates were significantly lower in the RCT by Eleftheriadou and colleagues, with 65% of patients in the phototherapy arm and 60% in the placebo arm experiencing repigmentation, but with most lesions showing less than 25% repigmentation.
“As [Eleftheriadou and colleagues] study’s primary outcome was not to assess effectiveness, the reason for this repigmentation was not discussed, although it may have been due to individual differences regarding disease progression, or there may have been other factors, such as failure of the plastic cover to block UVB emissions completely,” Dr Cohen and colleagues noted.
Collectively, the studies showed that QOL in patients with vitiligo was significantly improved when high levels of repigmentation were observed. In contrast, low repigmentation rates were associated with little change in QOL.
The two studies directly comparing home- and institution-based phototherapy showed home based treatment to be linked with notably better adherence to treatment schedules. Overall, 13% of individuals receiving institution-based phototherapy and 0% of patients using home-based phototherapy discontinued treatment due to lack of time or missing too many treatments. In the study comparing home-based phototherapy with placebo phototherapy, 68% and 64% of participants receiving these treatments, respectively, reported that they would use home-based phototherapy again and would recommend it to others because of its flexibility.
Treatment-Related Adverse Events
Higher in Home-Based Phototherapy
In all three RCTs, TRAEs were significantly higher with home-based phototherapy versus institution- or placebo-based phototherapy (Figure). When considering the two studies comparing home- versus institution-based phototherapy, there was an almost five-fold higher risk for AEs. When considering the study comparing home versus placebo-based phototherapy groups, TRAEs occurred in 68% versus 20% of participants, respectively.
Home-based phototherapy was associated with several serious AEs, including excessive hyper pigmentation, blistering, enlargement of vitiligo patches, and the appearance of new skin lesions on previously unaffected skin due to trauma. In contrast, TRAEs with institution-based phototherapy were considered mild and mostly included erythema and burning.
“At present, home-based phototherapy cannot be routinely recommended in clinical practice, as current data are insufficient to form conclusions about its effectiveness, and there is a potential increase in the risk of side effects. Furthermore, there is a lack of long-term data on maintenance of repigmentation,” Dr. Cohen and colleagues wrote. However, they noted that because home-based phototherapy may enable patients living in remote areas to access treatment, it warrants further investigation in large-scale, well-designed RCTs that can provide more definitive answers regarding its safety and efficacy.