Narrowband vs broadband ultraviolet B phototherapy for adults with moderate-to-severe atopic dermatitis: a randomized controlled trial

INTRODUCTION: Ultraviolet B (UVB) phototherapy is recommended in clinical guidelines for atopic dermatitis, but it is uncertain whether narrowband or broadband UVB is more effective and better tolerated. OBJECTIVES: The objective of this parallel-group randomized clinical trial was to compare the efficacy and safety of broadband vs. narrowband UVB for the treatment of moderate-to-severe atopic dermatitis. METHODS: Participants were 18 years and older with moderate-to-severe atopic dermatitis refractory to topical corticosteroids. Participants were randomized 1:1 via a centralized computer randomization scheme to full-body broadband or narrowband UVB phototherapy, with ongoing concomitant topical therapy. Participants were blinded but treating and assessing clinicians were not. The primary outcome was change in Eczema Area and Severity Index (EASI) at 12 weeks. Secondary outcomes included achieving 0 or 1 and improvement of 2 or more on the validated Investor Global Assessment scale (vIGA) and change in Patient-Oriented Eczema Measure (POEM), Peak Pruritus Numeric Rating Scale (PP-NRS), Dermatology Life Quality Index (DLQI) and Recap of atopic eczema RECAP). Efficacy analyses were conducted on a modified intention-to-treat population, including all randomized participants who receive at least one dose of phototherapy. RESULTS: 34 participants were randomized to broadband UVB and 35 to narrowband UVB. 32 participants received at least one dose of broadband UVB and 34 received at least one dose of narrowband UVB and were included in the modified intention-to-treat analysis. The mean age was 37.1 years in the broadband UVB arm and 33.2 in the narrowband UVB arm. The mean (95% credible interval) change in EASI score in the broadband UVB arm was -8.1 (-12.1 to -4.1) and in the narrowband UVB arm was -8.9 (-13.0 to -4.9). In the adjusted analysis, the difference between arms in change in EASI was -0.7 (-5.6 to 4.1). There were no significant differences between arms for any of vIGA, POEM, PP-NRS, DLQI or RECAP. There were 4 withdrawals from phototherapy due to adverse events in the broadband arm and 0 in the narrowband arm. CONCLUSIONS: In this study, broadband and narrowband UVB were similarly effective and narrowband UVB was better tolerated for the treatment of moderate-to-severe atopic dermatitis.