Topical corticosteroid and home-based narrowband UVB for localised vitiligo

  • Thomas KS & al.
  • Br J Dermatol
  • 2 Oct 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Combination treatment with hand-held narrowband-ultraviolet B (NB-UVB) light and potent topical corticosteroid (TCS) is likely to result in improved treatment response in patients with localised non-segmental vitiligo compared with potent TCS alone.
  • Both treatments are relatively safe and well tolerated, but were only successful in around a quarter of participants.

Why this matters

  • Combination treatment with potent TCS and NB-UVB may be helpful for people with vitiligo requiring second-line therapy.

Study design

  • In this HI-Light Vitiligo trial, 517 patients with vitiligo (398 adults; 119 children) were randomly assigned to receive TCS (mometasone furoate, n=173), NB-UVB (n=169) or TCS plus NB-UVB (n=175).
  • Primary outcome: treatment success at the target patch of vitiligo after 9 months, assessed using participant-reported Vitiligo Noticeability Scale.
  • Funding: National Institute for Health Research Health Technology Assessment Programme.

Key results

  • At 9 months, target patch treatment success was 17% for TCS, 22% for NB-UVB, and 27% for combination treatment.
  • Combination therapy of TCS plus NB-UVB was superior to TCS (adjusted between-group difference, 10.9%; 95% CI, 1.0-20.9%; P=.032).
  • NB-UVB alone was not superior to TCS (adjusted between-group difference, 5.2%; 95% CI, −4.4 to 14.9%; P=.290).
  • Treatment effects were largest in patients who adhered to the interventions >75% of the time, but effects were lost once treatment stopped.
  • A total of 124 (25%) patients reported 206 treatment-related adverse events (14% in the TCS, 28% in the NB-UVB, and 30% in the combination group).
  • Grade 3 and 4 erythemas constituted the majority of adverse events in the NB-UVB and combination groups.

Limitations

  • As loss to follow-up was higher, the trial lacked power to provide a high level of precision around the point estimates.