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Increasing Patient Access to Phototherapy

Increasing Patient Access to Phototherapy

Lite study

As part of its ongoing mission to help with the management of psoriasis and research for milestones to a cure, the National Psoriasis Foundation (NPF) is participating in a new, real-world clinical trial studying the effectiveness and safety of home-based vs office-based phototherapy, and providing opportunities to help increase patient access to the treatment.

Phototherapy has long been used as a treatment for mild to moderate psoriasis, both as a monotherapy and in combination with other treatments.1 A number of delivery mechanisms now exist (see Table), but the majority of the time, phototherapy treatments are performed in a hospital or dermatology office, which presents some disadvantages to patients.2 

In 2017, the Patient-Centered Outcomes Research Institute (PCORI) awarded an $8.6 million contract to Joel Gelfand, MD, professor of dermatology and epidemiology and vice chair of dermatology clinical research at the University of Pennsylvania in Philadelphia, to conduct the LITE study, a pragmatic clinical trial comparing the effectiveness and safety of 12 weeks of home-based vs office-based phototherapy for the treatment of psoriasis under real-world conditions. 

The LITE study is being conducted collaboratively by the NPF and dermatologists at the University of Pennsylvania and the University of Utah. Dr Gelfand is the principal investigator. The co-principal investigator is Kristina Callis Duffin, MD, co-chair of the department of dermatology at the University of Utah and an NPF Medical Board member. 

Patient-Centered Care

The study will help patients like Eric Fielding, a 55-year-old husband and father from Herndon, VA, who credits phototherapy for turning his psoriasis from “terrible” to “almost nothing.” He began phototherapy in 2014 at the suggestion of his dermatologist at the time, who did not offer this treatment at his practice. 

“Light therapy is great if you have access to a doctor who can provide it,” Mr Fielding said. “My drive was 10-plus miles each way, three times a week.” Mr Fielding lives in the Washington, DC, area, where a 10-mile drive can take an hour due to traffic.

table

Before Mr Fielding started light therapy, he had been treated only with topicals, and his body was covered in lesions. But the dermatologist’s light box had him almost completely cleared within 3 or 4 months. “The days of a drawer full of 20 different tubes of cortisone creams were over,” he said. “Ever since, my light therapy has just been maintenance.”

After a few months of battling traffic, Mr Fielding arranged with his insurer to do his treatments at home. He got his own narrowband UV-B, three-wing light box in May 2015. Now his phototherapy sessions—2 or 3 times a week, for 10 minutes each time—are a snap. “If I’m watching TV, my wife might remind me to do my light therapy. I’ll be back in just a few minutes,” he said.

Inside the Study

LITE is a randomized controlled study of phototherapy in 1050 patients aged 12 and older with plaque or guttate psoriasis who have phototherapy administered either at home or at their health care provider’s office/facility. Patients randomized to home treatment will receive home phototherapy units. 

The LITE study is specifically designed to have equal representation of all skin types and thus will be the most diverse psoriasis phototherapy trial ever conducted. The study will examine whether patients with fairer skin are more prone to problems with tolerability, such as burns from increased light penetration, and whether those with darker skin are more prone to problems with effectiveness due to decreased UV light penetration.  

LITE launched in 2019 with sites nationwide enrolling participants. Enrollment is scheduled to continue through 2022, and the project is scheduled to end the following year. The criteria for enrolling patients in the study are as follows:

  • Patient has plaque or guttate psoriasis
  • Patient is a candidate for office or home phototherapy
  • Patient is aged 12 or older
  • No washouts of topical, oral, or biologic medications required
  • Join LITE

“The LITE study reflects challenges seen in clinical practices like yours,” said Dr Gelfand. “It is easily incorporated into routine patient care. The data you’ll collect are the data you would have routinely collected in your clinical practice.”

Looking to the future, Dr Gelfand added, “LITE could someday provide the data necessary to better inform treatment decisions for hundreds of thousands of phototherapy candidates, while at the same time transforming clinical trials to be more patient-centered and designed to reflect actual clinical practice.”

If you offer narrowband UV-B phototherapy in your office, and want to join the LITE study, visit thelitestudy.com, or email research@psoriasis.org to become a clinical site. 

 

Note: PCORI was established by the 2010 Patient Protection and Affordable Care Act. It is a 501(c)(1) organization. Funding from PCORI comes solely from the federal government.

References

1. Zhang P, Wu MX. A clinical review of phototherapy for psoriasis. Lasers Med Sci. 2018;33(1):173–180. doi:10.1007/s10103-017-2360-1

2. Nakamura, M, Farahnik B, Bhutani T. Recent advances in phototherapy for psoriasis [published online July 13, 2016]. F1000Res. doi:10.12688/f1000research.8846.1

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