- Primary endpoint: Mean % change in F-VASI at week 24 better with NB-UVB vs PUVA (−48.6% vs −39.2%; Δ −9.4 pp; p=0.031).
- Face/neck response (≥50% repigmentation): 62% NB-UVB vs 46% PUVA.
- Adverse events: less nausea and phototoxicity with NB-UVB; comparable erythema.
Abstract
Objective: Compare NB-UVB 311 nm and PUVA in non-segmental vitiligo over 24 weeks.
Design: Randomized, parallel-group, open-label with blinded assessors; multicenter (3 sites).
Participants: N=118 adults (NB-UVB n=59; PUVA n=59); disease duration median 4.2 years.
Primary endpoint: % change in Facial VASI (F-VASI) at week 24.
Methods
- Inclusion: Non-segmental vitiligo, F-VASI ≥1.0, stable or active.
- Treatment: NB-UVB 3×/week (dose-escalation per erythema); PUVA 2×/week (8-MOP 0.6 mg/kg).
- Assessments: F-VASI, T-VASI, PGA, photo-documentation (week 0, 8, 16, 24).
- Stats: MMRM; missing data via multiple imputation; alpha=0.05 (two-sided).
| Parameter | NB-UVB 311 nm | PUVA |
|---|---|---|
| Frequency | 3× per week | 2× per week |
| Starting dose | 200 mJ/cm² | 8-MOP 0.6 mg/kg + UVA |
| Dose escalation | +10–20% if no erythema | +0.5–1 J/cm² per tolerance |
| Max dose | 1,200 mJ/cm² | Up to 12 J/cm² |
| Duration | 24 weeks | |
Results
| Outcome | NB-UVB (n=59) | PUVA (n=59) | Between-group Δ (95% CI) | p-value |
|---|---|---|---|---|
| F-VASI % change (↓ better) | −48.6% | −39.2% | −9.4 pp (−18.0, −0.9) | 0.031 |
| T-VASI % change | −31.7% | −25.5% | −6.2 pp (−12.9, +0.5) | 0.070 |
| ≥50% repigmentation (face/neck) | 62% | 46% | RR 1.35 (1.02–1.78) | 0.036 |
Sensitivity analyses (per-protocol, tipping-point) confirmed robustness of the primary endpoint.
Safety
| Event | NB-UVB | PUVA |
|---|---|---|
| Erythema (mild/moderate) | 28% | 26% |
| Nausea | 2% | 17% |
| Phototoxic reaction | 0% | 7% |
Subgroup Analyses
- Disease activity: benefit of NB-UVB consistent in stable and active subsets (interaction p=0.41).
- Phototype: greater absolute F-VASI reductions in III–IV vs I–II; no treatment×phototype interaction.
Limitations
Open-label design (with blinded assessors), 24-week duration, no maintenance phase, and center-level heterogeneity may limit generalizability.
Conclusion
NB-UVB 311 nm provided superior facial repigmentation at 24 weeks versus PUVA with a more favorable tolerability profile. Findings support NB-UVB as first-line phototherapy in non-segmental vitiligo.
References
- Njoo MD, et al. Narrowband UVB phototherapy in vitiligo… Arch Dermatol. 1998.
- Hamzavi I, Lim HW, et al. Current and emerging treatments… Dermatol Clin. 2020.
- Ezzedine K, Lim HW, et al. Consensus classification… Pigment Cell Melanoma Res. 2015.