Daijiworld Media Network – New Delhi
New Delhi, Jan 4: Adjunctive narrowband ultraviolet B (NB-UVB) phototherapy may help restore clinical response in patients with chronic plaque psoriasis who develop secondary failure to adalimumab, according to a small prospective exploratory cohort study.
Biologic therapies have significantly improved psoriasis management, but loss of efficacy over time remains a major challenge. While switching to another biologic is a common strategy, researchers note that combination approaches could offer a more cost-effective alternative. NB-UVB phototherapy, a well-established psoriasis treatment with local immunomodulatory effects, has so far had limited evidence supporting its use alongside biologics such as tumour necrosis factor (TNF) inhibitors.
In the study, researchers followed 11 adult patients with chronic plaque psoriasis who had experienced secondary loss of response to adalimumab, without developing anti-adalimumab antibodies. All participants continued standard-dose adalimumab (40 mg every two weeks) and received adjunctive NB-UVB phototherapy three times a week for 25–30 sessions.
Disease severity was measured using the Psoriasis Area and Severity Index (PASI). Mean PASI increased from 4.1 at baseline to 11.8 at relapse, indicating clinically significant worsening. After NB-UVB treatment, mean PASI dropped to 6.2, showing a statistically significant improvement. When non-responders were excluded, mean PASI further declined to 4.0, comparable to pre-relapse levels.
Overall, five patients (45.5%) achieved a PASI 50 response, while two patients (18.2%) reached PASI 75. Notably, the clinical benefits were maintained for at least 24 months, suggesting a durable response to the combination therapy.
Patient-reported outcomes also showed marked improvement. The mean Dermatology Life Quality Index (DLQI) score fell from 14.7 at relapse, reflecting severe quality-of-life impairment, to 5.6 following NB-UVB therapy, indicating a substantial reduction in disease burden.
NB-UVB was well tolerated, with no significant adverse events reported. Three patients who did not respond to the combination approach were later switched to ustekinumab.
The researchers concluded that adjunctive NB-UVB phototherapy could be a safe, accessible and cost-conscious strategy to restore adalimumab efficacy in patients with secondary treatment failure. However, they stressed that larger controlled studies are required to confirm these findings and better define the role of combination therapy in psoriasis care.