Topical Corticosteroid and Home-based Narrowband UVB for Localised Vitiligo

Sarfaroj Khan 

Disclosures

October 09, 2020

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.

 

Thomas KS, Batchelor JM, Akram P, Chalmers JR, Haines RH, Meakin GD, Duley L, Ravenscroft JC, Rogers A, Sach TH, Santer M, Tan W, White J, Whitton ME, Williams HC, Cheung ST, Hamad H, Wright A, Ingram JR, Levell NJ, Goulding JMR, Makrygeorgou A, Bewley A, Ogboli M, Stainforth J, Ferguson A, Laguda B, Wahie S, Ellis R, Azad J, Rajasekaran A, Eleftheriadou V, Montgomery AA; UK Dermatology Clinical Trials Network’s HI-LIGHT Vitiligo Trial Team. Randomised controlled trial of topical corticosteroid and home-based narrowband UVB for active and limited vitiligo - results of the HI-Light Vitiligo trial. Br J Dermatol. 2020 Oct 2 [Epub ahead of print]. doi: 10.1111/bjd.19592. PMID: 33006767 View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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