Narrow‐band ultraviolet B phototherapy versus broad‐band ultraviolet B or psoralen‐ultraviolet A photochemotherapy for psoriasis

Xiaomei Chen<sup>a</sup>; Ming Yang<sup>a</sup>; Yan Cheng; Guan J Liu; Min Zhang

doi:10.1002/14651858.CD009481.pub2

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Figure 1

Study flow diagram

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Figure 2

'Risk of bias' summary: Review authors' judgements about each 'Risk of bias' item for each included study

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Figure 3

'Risk of bias' graph: Review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies

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Analysis 1.1

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 1 PASI 75.

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Analysis 1.2

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 2 PASI 75 (ITT analysis).

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Analysis 1.3

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 3 Withdrawals due to side‐effects.

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Analysis 1.4

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 4 Withdrawals due to side‐effects (ITT analysis).

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Analysis 1.5

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 5 Clearance rate.

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Analysis 1.6

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 6 Clearance rate (ITT analysis).

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Analysis 1.7

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 7 Clearance lasting 6 months.

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Analysis 1.8

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 8 Time to PASI 75.

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Analysis 1.9

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 9 Relapse rate at 6 months after treatment completion.

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Analysis 1.10

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 10 Withdrawals due to poor response.

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Analysis 1.11

Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 11 Adverse events.

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Analysis 2.1

Comparison 2 NB‐UVB versus bath PUVA in CPP, Outcome 1 Clearance rate.

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Analysis 2.2

Comparison 2 NB‐UVB versus bath PUVA in CPP, Outcome 2 Clearance rate (ITT analysis).

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Analysis 2.3

Comparison 2 NB‐UVB versus bath PUVA in CPP, Outcome 3 PASI score reduction.

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Analysis 2.4

Comparison 2 NB‐UVB versus bath PUVA in CPP, Outcome 4 Adverse events.

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Analysis 3.1

Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 1 Clearance rate.

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Analysis 3.2

Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 2 Clearance rate (ITT analysis).

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Analysis 3.3

Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 3 Relapse at 9 weeks after treatment completion.

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Analysis 3.4

Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 4 Marked improvement.

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Analysis 3.5

Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 5 Adverse events.

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Analysis 4.1

Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 1 PASI.

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Analysis 4.2

Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 2 PASI 75 (ITT analysis).

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Analysis 4.3

Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 3 Clearance rate.

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Analysis 4.4

Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 4 Clearance rate (ITT analysis).

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Analysis 4.5

Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 5 Relapse at 6 months after treatment completion.

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Analysis 4.6

Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 6 Clinical improvement.

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Analysis 4.7

Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 7 Tolerability assessed as good or very good by observers (ITT analysis).

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Analysis 4.8

Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 8 Tolerability assessed as good or very good by participants (ITT analysis).

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Analysis 4.9

Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 9 Adverse events.

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Analysis 5.1

Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 1 Withdrawal due to side‐effects.

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Analysis 5.2

Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 2 Withdrawals due to side‐effects (ITT analysis).

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Analysis 5.3

Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 3 Clearance rate.

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Analysis 5.4

Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 4 Clearance rate (ITT analysis).

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Analysis 5.5

Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 5 Clearance lasting 6 months.

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Analysis 5.6

Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 6 Adverse events.

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Analysis 6.1

Comparison 6 NB‐UVB versus conventional BB‐UVB in different types of psoriasis, Outcome 1 Cumulative UV dose during the study.

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Analysis 7.1

Comparison 7 NB‐UVB plus dithranol versus conventional BB‐UVB plus dithranol in different types of psoriasis, Outcome 1 Cumulative UV dose during the study.

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Summary of findings for the main comparison. NB‐UVB compared with oral PUVA for chronic plaque psoriasis

NB‐UVB compared with oral PUVA for chronic plaque psoriasis
Patient or population: People with chronic plaque psoriasis Settings: ‐ Intervention: NB‐UVB Comparison: Oral PUVA
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Oral PUVA	NB‐UVB
Participant‐rated global improvement	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Percentage of participants reaching PASI 75	720 per 1000	655 per 1000 (454 to 950)	RR 0.91 (0.63 to 1.32)	51 (1 study)	⊕⊕⊝⊝ low¹, ²	This is the result of ITT analysis
Withdrawal due to side‐effects	32 per 1000	50 per 1000 (7 to 82)	RR 0.71 (0.20 to 2.54)	247 (3 study)	⊕⊕⊝⊝ low³	This is the result of ITT analysis
Clearance rate	Study population		Not estimable	0 (0)	See comment	The results of 3 small RCTs are contradictory. Because of the significant statistical heterogeneity, the data were not pooled
	See comment	See comment
	Moderate

Comment: The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in the footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ The study was of small sample size. ² The study was at high risk of bias. ³ All of the 3 studies were of small sample size and at high risk of bias, and the result was based on less than 300 participants.

Summary of findings for the main comparison. NB‐UVB compared with oral PUVA for chronic plaque psoriasis

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Summary of findings 2. NB‐UVB compared with bath PUVA for chronic plaque psoriasis

NB‐UVB compared with bath PUVA for chronic plaque psoriasis
Patient or population: People with chronic plaque psoriasis Settings: ‐ Intervention: NB‐UVB Comparison: Bath PUVA
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Bath PUVA	NB‐UVB
Participant‐rated global improvement	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Percentage of participants reaching PASI 75	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Withdrawal due to side‐effects	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Clearance rate	348 per 1000	623 per 1000 (160 to 1000)	RR 1.79 (0.46 to 6.91)	92 (2 studies)	⊕⊕⊝⊝ low¹	1. On the basis of studies performing left‐right body comparison. 2. This is the result of ITT analysis
Clearance rate	611 per 1000	110 per 1000 (31 to 434)	RR 0.18 (0.05 to 0.71)	36 (1 study)	⊕⊕⊝⊝ low², ³	1. On the basis of the study performing comparison between participants. 2. This is the result of ITT analysis
Comment: The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in the footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Both of the studies were of small sample size and at high risk of bias, and the result was based on less than 300 participants. ² The study was at high risk of bias. ³ The study was of small sample size, and the result was based on less than 300 participants.

Summary of findings 2. NB‐UVB compared with bath PUVA for chronic plaque psoriasis

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Summary of findings 3. NB‐UVB compared with topical PUVA for palmoplantar psoriasis

NB‐UVB compared with topical PUVA for palmoplantar psoriasis
Patient or population: People with palmoplantar psoriasis Settings: ‐ Intervention: NB‐UVB Comparison: Topical PUVA
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Topical PUVA	NB‐UVB
Participant‐rated global improvement	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Percentage of participants reaching PASI 75	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Withdrawal due to side‐effects	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Clearance rate	200 per 1000	18 per 1000 (2 to 312)	RR 0.09 (0.01 to 1.56)	50 (1 study)	⊕⊕⊝⊝ low¹, ²	This is the result of ITT analysis
* Comment: The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ This study was at unclear risk of bias. ² The study was of small sample size, and the result was based on less than 300 participants.

Summary of findings 3. NB‐UVB compared with topical PUVA for palmoplantar psoriasis

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Summary of findings 4. NB‐UVB plus retinoid compared with PUVA plus retinoid for chronic plaque or guttate psoriasis

NB‐UVB plus retinoid compared with PUVA plus retinoid for chronic plaque or guttate psoriasis
Patient or population: People with chronic plaque or guttate psoriasis Settings: ‐ Intervention: NB‐UVB plus retinoid Comparison: PUVA plus retinoid
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	PUVA plus retinoid	NB‐UVB plus retinoid
Participant‐rated global improvement	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Percentage of participants reaching PASI 75	Study population		RR 0.89 (0.59 to 1.35)	60 (1 study)	⊕⊕⊝⊝ low¹, ²	This is the result of ITT analysis
	633 per 1000	564 per 1000 (374 to 855)
	Moderate

Withdrawal due to side‐effects	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Clearance rate	756 per 1000	688 per 1000 (544 to 831)	RR 0.93 (0.79 to 1.10)	90 (2 studies)	⊕⊕⊝⊝ low², ³	This is the result of ITT analysis
Comment: The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ This study was at high risk of bias. ² The studies were of small sample size, and the result was based on less than 300 people. ³ Both of the studies were at high risk of bias.

Summary of findings 4. NB‐UVB plus retinoid compared with PUVA plus retinoid for chronic plaque or guttate psoriasis

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Summary of findings 5. NB‐UVB compared with selective BB‐UVB for chronic plaque psoriasis

NB‐UVB compared with selective BB‐UVB for chronic plaque psoriasis
Patient or population: People with chronic plaque psoriasis Settings: ‐ Intervention: NB‐UVB Comparison: Selective BB‐UVB
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Selective BB‐UVB	NB‐UVB
Participant‐rated global improvement	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Percentage of participants reaching PASI 75	Study population		Not estimable	0 (0)	See comment	No included RCT addressed this outcome
	See comment	See comment
	Moderate

Withdrawal due to side‐effects	Study population		RR 3.00 (0.32 to 27.87)	100 (1 study)	⊕⊕⊝⊝ low¹, ²	This is the result of ITT analysis
	20 per 1000	60 per 1000 (6 to 557)
	Moderate

Clearance rate	400 per 1000	560 per 1000 (368 to 852)	RR 1.40 (0.92 to 2.13)	100 (1 study)	⊕⊕⊝⊝ low¹, ²	This is the result of ITT analysis
Comment: The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ The study was at unclear risk of bias. ² The study was of small sample size, and the result was based on less than 300 people.

Summary of findings 5. NB‐UVB compared with selective BB‐UVB for chronic plaque psoriasis

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Table 1. Glossary of some important terms and abbreviations used

Medical term and abbreviations	Explanation
Apoptosis	The process of programmed cell death that occurs during growth and development of multicellular organisms. It is generally considered a part of normal cell aging, but it can also be a response to cellular injury
BB‐UVB	Broad‐band ultraviolet B
Collagenase	An enzyme that breaks the peptide bonds in collagen
CPP	Chronic plaque psoriasis
Cytokines	Small protein molecules that are secreted by cells of the nervous system or the immune system. They are used in intercellular communication
Defective maturation of epidermal keratinocytes	Incomplete formation of keratin (the horny material in nails) due to rapid growth of cells in the epidermal layer of the skin
Dilatation of dermal capillaries	Dilation of small blood vessels in the skin
Erythrodermic psoriasis	A subtype of psoriasis that affects nearly all body sites
Erythrogenic response	Redness of the skin caused by light exposure
Extensor aspects	An anatomical term ‐ when a joint bends, the parts of the skin on the opposite side of the joint are called the extensor aspects
Hyperkeratosis	Thickening of the stratum corneum (outermost layer of the skin) usually associated with an abnormality of the keratin and an increase of the granular layer of the skin
Hyperplasia	An increase in the number of cells
Hyperproliferation	An abnormally high rate of proliferation of cells by rapid division
Hypertriglyceridaemia	High levels of triglyceride fatty acids
ITT	Intention‐to‐treat: An ITT analysis is often recommended as the least biased way to estimate intervention effects in RCTs. The principals of ITT analysis are as follows: 1. keep participants in the intervention group to which they were randomised, regardless of the intervention they actually received; 2. measure outcome data on all participants; and 3. include all randomised participants in the analysis
MRA	Minimal residual activity
MOP	Methoxypsoralen
NB‐UVB	Narrow‐band ultraviolet B
Paronychia	Swelling of the skin over the nail
PASI	Psoriasis Area and Severity Index. The higher the score, the more severe the lesions are
PASI 75	Equal to or more than 75% reduction in PASI score
PPP	Palmoplantar psoriasis
Psoralen	A compound that can be used as a kind of photosensitiser to improve the influence of natural or artificial light
PUVA	Psoralen plus ultraviolet A
Photosensitiser	Chemical treatments that are used to sensitise the skin and enhance the effect of light treatments
Pustular	Lesions containing purulent materials
QOL	Quality of life
Re‐NB‐UVB	NB‐UVB combined with retinoid
Re‐PUVA	PUVA combined with retinoid
Severity index of PPP	A tool developed by Hofer 2006 to evaluate the severity of palmoplantar psoriasis. The separate scores of erythema, scaling, pustulation, and infiltration for palms and soles were added to calculate the severity index (0 = absent; 1 = slight; 2 = moderate; 3 = marked; and 4 = very marked)
Xerophthalmia	Dryness of the eye, especially the cornea and conjunctiva
Xerosis	Extreme dryness of the skin

Table 1. Glossary of some important terms and abbreviations used

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Comparison 1. NB‐UVB versus oral PUVA in CPP

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 PASI 75 Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2 PASI 75 (ITT analysis) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Withdrawals due to side‐effects Show forest plot	3	231	Risk Ratio (M‐H, Random, 95% CI)	0.69 [0.19, 2.43]

4 Withdrawals due to side‐effects (ITT analysis) Show forest plot	3	247	Risk Ratio (M‐H, Random, 95% CI)	0.71 [0.20, 2.54]

5 Clearance rate Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

6 Clearance rate (ITT analysis) Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

7 Clearance lasting 6 months Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

8 Time to PASI 75 Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

9 Relapse rate at 6 months after treatment completion Show forest plot	3	172	Risk Ratio (M‐H, Random, 95% CI)	1.08 [0.74, 1.58]

10 Withdrawals due to poor response Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

11 Adverse events Show forest plot	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

11.1 erythema	3	233	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.47, 2.09]
11.2 nausea	2	131	Risk Ratio (M‐H, Random, 95% CI)	0.12 [0.02, 0.94]
11.3 pruritus	1	43	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.31, 2.43]
11.4 PMLE	1	43	Risk Ratio (M‐H, Random, 95% CI)	1.05 [0.16, 6.77]
11.5 grade 1 erythema	1	45	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.68, 1.26]
11.6 grade 2 erythema	1	88	Risk Ratio (M‐H, Random, 95% CI)	0.48 [0.13, 1.79]
11.7 any adverse events	1	43	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.40, 2.08]

Comparison 1. NB‐UVB versus oral PUVA in CPP

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Comparison 2. NB‐UVB versus bath PUVA in CPP

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clearance rate Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Studies performing left‐right body comparison	2	70	Risk Ratio (M‐H, Random, 95% CI)	2.03 [0.29, 14.06]
1.2 Study performing comparison between participants	1	34	Risk Ratio (M‐H, Random, 95% CI)	0.20 [0.05, 0.79]
2 Clearance rate (ITT analysis) Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Studies performing left‐right body comparison	2	92	Risk Ratio (M‐H, Random, 95% CI)	1.79 [0.46, 6.91]
2.2 Studies performing comparisons between participants	1	36	Risk Ratio (M‐H, Random, 95% CI)	0.18 [0.05, 0.71]
3 PASI score reduction Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

4 Adverse events Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

4.1 erythema	2		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.2 pruritus	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.3 grade 1 erythema	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.4 grade 2 erythema	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.5 grade 3 erythema	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.6 folliculitis	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.7 any adverse events	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. NB‐UVB versus bath PUVA in CPP

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Comparison 3. NB‐UVB versus topical PUVA in PPP

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clearance rate Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2 Clearance rate (ITT analysis) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Relapse at 9 weeks after treatment completion Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

4 Marked improvement Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

5 Adverse events Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

5.1 palmar hyperpigmentation	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. NB‐UVB versus topical PUVA in PPP

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Comparison 4. NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 PASI Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2 PASI 75 (ITT analysis) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Clearance rate Show forest plot	2	82	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.78, 1.07]

4 Clearance rate (ITT analysis) Show forest plot	2	90	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.79, 1.10]

5 Relapse at 6 months after treatment completion Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

6 Clinical improvement Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

6.1 Marked improvement (50% to 75% improvement in PASI, ITT analysis)	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.2 Moderate improvement (25% to 50% improvement in PASI, ITT analysis)	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.3 Slight improvement (5% to 25% improvement in PASI, ITT analysis)	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.4 No improvement (< 5% improvement in PASI, ITT analysis)	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
7 Tolerability assessed as good or very good by observers (ITT analysis) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

8 Tolerability assessed as good or very good by participants (ITT analysis) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

9 Adverse events Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

9.1 erythema	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
9.2 diffuse hair loss	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
9.3 reversible hypertriglyceridaemia	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
9.4 withdrawal due to pruritus and burning	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
9.5 nausea	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis

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Comparison 5. NB‐UVB versus selective BB‐UVB in CPP

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Withdrawal due to side‐effects Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2 Withdrawals due to side‐effects (ITT analysis) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Clearance rate Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

4 Clearance rate (ITT analysis) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

5 Clearance lasting 6 months Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

6 Adverse events Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

6.1 severe erythema	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.2 PMLE	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.3 pruritus	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. NB‐UVB versus selective BB‐UVB in CPP

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Comparison 6. NB‐UVB versus conventional BB‐UVB in different types of psoriasis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cumulative UV dose during the study Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

Comparison 6. NB‐UVB versus conventional BB‐UVB in different types of psoriasis

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Comparison 7. NB‐UVB plus dithranol versus conventional BB‐UVB plus dithranol in different types of psoriasis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cumulative UV dose during the study Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

Comparison 7. NB‐UVB plus dithranol versus conventional BB‐UVB plus dithranol in different types of psoriasis

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