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Adherence to acitretin and home narrowband ultraviolet B phototherapy in patients with psoriasis

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Background

In the treatment of psoriasis, patient adherence to oral medications is poor and even worse for topical therapy. However, few data exist about adherence rates to home phototherapy, adding to concerns about the appropriateness of home phototherapy as a psoriasis treatment option.

Objective

We sought to assess adherence to both oral acitretin and home ultraviolet B phototherapy for the treatment of psoriasis.

Methods

In all, 27 patients with moderate to severe psoriasis were treated with 10 to 25 mg of acitretin daily, combined with narrowband ultraviolet B, 3 times weekly at home, for 12 weeks. Adherence to acitretin was monitored by an electronic monitoring medication bottle cap, and to phototherapy by a light-sensing data logger.

Results

Adherence data were collected on 22 patients for acitretin and 16 patients for adherence to ultraviolet B. Mean adherence to acitretin decreased steadily during the 12-week trial (slope −0.24), whereas mean adherence to home phototherapy remained steady at 2 to 3 d/wk. Adherence was similar between patients who reported side effects and those who did not.

Limitations

Small sample size and lack of follow-up on some patients were limitations of this study.

Conclusions

Adherence rates to home phototherapy were very good and higher than adherence rates for the oral medication. Side effects of treatment were well tolerated in this small group and did not affect use of the treatment. Home phototherapy with acitretin may be an appropriate option for some patients with extensive psoriasis.

Section snippets

Methods

After obtaining institutional review board approval, 27 patients were recruited with moderate to severe plaque-type psoriasis, defined as a body surface area coverage greater than 10% and either a Psoriasis Area Severity Index score greater than or equal to 12 or an Investigator Global Assessment score greater than or equal to 3. Eligible patients were adult men and women not of childbearing potential with no contraindications to acitretin or phototherapy. A 4-week washout was required for any

Results

Of the 27 enrolled participants, 22 completed the 12-week study (Fig 1). Of the patients, 63% were men, 70% were Fitzpatrick skin types I or II, and the mean age was 50 years (Table I). Secondary to elevated triglycerides, the daily acitretin dose was reduced to 10 mg in 4 of the patients. Adherence data were collected on all 22 patients for acitretin, but data were available on only 16 patients for UVB adherence (Fig 1) secondary to difficulties with retrieval of the monitors from

Discussion

Adherence to treatment remains a major obstacle in the care of patients with psoriasis. Many factors influence a patient's adherence to a given therapy, including perceptions about safety, side effects, time consumption, and complexity of the regimen.11, 12, 13 If patients have the perception that the prescribed treatment is not safe, or if they experience side effects from the medication, they are less likely to use it.12 Likewise, if the treatment regimen is perceived as too complex or

References (14)

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Supported by National Biologic Corporation and Connetics.

Disclosure: Dr Feldman has received research, speaking, and/or consulting support from Connetics, Roche, Amgen, Biogen, and Genentech. Drs Yentzer, Yelverton, Pearce, Fleischer, and Balkrishnan; Mr Camacho; Ms Makhzoumi; Ms Clark; and Ms Boles have no conflicts of interest to declare.

Reprints not available from the authors.

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