Kenneth A. Katz, MD, MSc, MSCE

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Around two-thirds of individuals who received home NBUVB (narrowband ultraviolet B) for psoriasis did not use in-office NBUVB or systemic therapy in the year after receiving the machine, according to new findings, which may indicate NNBUVB’s effectiveness and convenience.¹

Despite being cost-effective and well-received by patients, home NBUVB for psoriasis has not been historically covered by patients’ insurance plans.² The new findings and others were the results of a new analysis first begun in 2015 by Kaiser Permanente Northern California investigators to identify and describe the characteristics of patients known to use either in-office NBUVB or systemic therapy after receiving an NBUVB machine.

To examine such characteristics, the investigators conducted their research, with the study being authored by Kenneth A. Katz, MD, MSc, MSCE, from Kaiser Permanente San Francisco Medical Center’s Dermatology Department.

“In 2015, Kaiser Permanente Northern California (KPNC) began covering home NBUVB,” Katz and colleagues wrote. “We describe and identify patient characteristics associated with use of in-office NBUVB or systemic therapy following home NBUVB machine receipt.”

Background and Findings

The investigators conducted the research within Kaiser Permanente Northern California, an around 4.6 million member-strong community-based, integrated health care delivery system. The team gathered data from electronic medical records of Kaiser members aged 18 years and older with 2 or more psoriasis-coded meetings at the time of or prior to a clinician ordering an NBUVB machine in the time between January of 2015, and December of 2019.

The study was approved by the KPNC Institutional Review Board with a waiver of consent due to data de-identification. The research team excluded participants without a minimum 365 days of continuous Kaiser Permanente Northern California membership before and after the machine’s order date, or those with codes for related conditions like rheumatoid arthritis, ulcerative colitis, psoriatic arthritis, Crohn disease, hidradenitis suppurativa, and others.

Study participants who filled a prescription for systemic therapy or had in-office NBUVB after 120 days of machine order date were also censored by the team, allowing for shipment of machines, device setup, and dosing ramp-up. The investigators used logistic regression as well as Kaplan-Meier curves for analysis, following the STROBE reporting guideline.

For validation, a single investigator reviewed the medical records of 124 members who had been randomly-selected, with 93.5% of these members having shown clinical presentations which were determined to have been consistent with psoriasis.

The investigators reported that previously published information included outcomes of Kaiser members who had biologic or apremilast treatment and had also received home NBUVB machines in the time between March 1, 2015, and April 29, 2016.

Overall, the research team noted that out of 2207 members, 57% were shown to be male and 43% female, with the group’s median age being 50.6 years. Among these participants, the team found that 64.8% did not use either in-office NBUVB or systemic therapy and 35.2% did, with 88.5% opting for systemic therapy and 11.5% for in-office NBUVB.

In the investigators’ multivariate analysis, they found that lack of use of in-office systemic therapy or NBUVB use was linked with lower Charlson Comorbidity Index (CCI) (OR, 0.68; 95% CI, 0.49 - 0.94 for CCI ≥2 vs 0), lower body mass index (BMI) (odds ratio [OR], 0.98; 95% CI, 0.96 - 0.99 per 1-unit increase in BMI), and a lack of previous systemic therapy (in those who were given prior systemic medications, OR, 0.06; 95% CI, 0.05 - 0.08 in those without prior NBUVB; OR, 0.07; 95% CI, 0.04 - 0.10 in those with NBUVB).

The investigators also noted that the majority of in-office NBUVB or systemic therapy use following the receipt of home NBUVB machine took place between 120 and 200 days among those they analyzed.

The team’s data suggested that nearly two-thirds of patients who received home NBUVB did not use in-office NBUVB or systemic therapy within a year following their receiving of the home NBUVB device. The investigators indicated that the lack of use of in-office treatments could be attributed to the effectiveness of home NBUVB treatment and its associated benefits, such as convenience, saving money, and potential avoidance of adverse effects from systemic therapies.

The other findings that use of in-office NBUVB or systemic treatment after home NBUVB machine receipt showed greater likelihood among those with higher Charlson Comorbidity Index (CCI), higher BMI, or those with systemic therapy experience could be due to worse baseline psoriasis conditions.

“Many patients with psoriasis did not use in-office NBUVB or systemic therapy for the first year after receiving home NBUVB,” they wrote. “Additional studies should help clarify home NBUVB benefits and risks.”

References

1. ^{Katz KA, Stram DA. Home Narrowband UV-B Treatment for Psoriasis: A Cohort Study. JAMA Dermatol. Published online August 02, 2023. doi:10.1001/jamadermatol.2023.2332.}
2. ^{Koek MB, Sigurdsson V, van Weelden H, Steegmans PH, Bruijnzeel-Koomen CA, Buskens E. Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study). BMJ. 2010;340:c1490. doi:10.1136/bmj.c1490.}