Mycosis Fungoides

In patients with early-stage mycosis fungoides, treatment and maintenance therapy with low dose;  frequency oral psoralen UV-A (PUVA) may extend disease free remission, a proof of concept study reveals. The results of the study have to be considered practice-changing, Dr. Peter Wolf of Medical University of Graz in Austria told Reuters Health by email.
The low-dose protocol they used in the study was as effective or even more effective than dose regimes use in previous studies and in current daily practice, they said, making the low-dose regime an attractive treatment concept that shall be safer concerning side effects such as carcinogenesis than the current standard of practice.
Moreover, they noted, there study identifiy potential biomarkers in serum predicting therapeutic response to PUVA. Dr. Wolf and colleagues conduct a randomize clinical trial of low dose; so low frequency oral PUVA with or without maintenance in 27 patients (70% men; mean age, 61) in five centers in Austria.

Patients in complete remission

During induction, PUVA was administer for 12 to 24 weeks until the score of a modify severity weight assessment tool; so (mSWAT) a quantification of the body surface area of each lesion multiply by a weighting factor for lesion type was reduce to 0. Patients in complete remission (CR) were then randomly assign; so to receive either PUVA maintenance therapy for nine months or no maintenance, and were evaluate at four, 12, 24, and 36 weeks after randomization.

Thereafter, they were assessed four times a year (first year), twice a year (second year); so then once a year (third to fifth year). As reported online March 20 in JAMA Dermatology, randomized patients had a mean mSWAT score of 18.6 at baseline. The 12- to 24-week PUVA induction regimen; which used a low mean cumulative UV-A dose of 78.5 J/cm2, reduced the mSWAT score in all patients and led to CR in 19 (70%).
In the maintenance group, four patients (36%) relapsed during maintenance; five (45%) relapsed after completing maintenance (months 13 to 31); and, at the closing date of the study; so two patients (18%) were still in remission (one for 49 months; one for 54 months. Overall, the nine-month PUVA maintenance phase prolonged median disease-free remission from four months to 15 months.

Dermatology practices in the U.S

Dr. Joan Guitart of Northwestern University’s Feinberg School of Medicine in Chicago; so author of a related editorial, told Reuters Health. PUVA has practically disappeared from dermatology practices in the U.S. PUVA was frequently and effectively used for the treatment of psoriasis; eczema and cutaneous lymphomas in the 1980s and ’90s,” they said by email.
The reasons for the fall of PUVA use in the last decade are complex. But most importantly, dermatologists became afraid of prescribing it when they learned about the common and often aggressive skin cancers that developed in patients treated with PUVA for long periods; so most often using high-dose therapy protocols.
This fact, compounded by the shortage of oral psoralens a few years ago and the advent of new biologics; so for the treatment of psoriasis led to the disappearance of PUVA from most dermatological practices,” they noted. This new study shows that PUVA administered using fewer treatments and with a lower dose; which can provide long-lasting remissions to our cutaneous lymphoma patients,” they said.
While they doubt this new study will significantly alter the use of PUVA in the U.S., it may stir interest among young dermatologists to revive its use utilizing the new proposed European protocol as an additional therapeutic tool for difficult-to-treat cases of psoriasis, eczema or cutaneous lymphomas, they concluded.