ADJUNCTIVE narrowband ultraviolet B (NB-UVB) phototherapy may help restore clinical response in patients with chronic plaque psoriasis who experience secondary failure to adalimumab, according to a small prospective exploratory cohort study.
Secondary Biologic Failure in Chronic Plaque Psoriasis
Biologic therapies have transformed psoriasis care, but loss of efficacy over time remains a persistent challenge. While switching biologics is common, combining treatments to recapture response may offer a cost-effective alternative. NB-UVB phototherapy is an established psoriasis treatment with local immunomodulatory effects, yet evidence supporting its use alongside biologics, particularly tumour necrosis factor (TNF) inhibitors such as adalimumab, has been limited.
In this study, researchers followed 11 adults with chronic plaque psoriasis who had developed secondary loss of response to adalimumab, in the absence of anti-adalimumab antibodies. All patients continued standard-dose adalimumab (40 mg every two weeks) and received adjunctive NB-UVB phototherapy three times weekly for 25–30 sessions.
Patient-Reported Outcomes After NB-UVB Treatment
Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Mean PASI rose from 4.1 at baseline to 11.8 at disease relapse, confirming clinically significant relapse. Following NB-UVB treatment, mean PASI decreased to 6.2, representing a statistically significant improvement. When non-responders were excluded, mean PASI fell to 4.0, comparable to pre-relapse disease levels.
Overall, five patients (45.5%) achieved a PASI 50 response, and two patients (18.2%) reached PASI 75. Importantly, clinical improvements were sustained for at least 24 months, suggesting durable benefit from the combination approach.
Patient-reported outcomes also improved. The mean Dermatology Life Quality Index (DLQI) score fell from 14.7 at point of relapse, reflecting severe quality-of-life impairment, to 5.6 after NB-UVB, indicating a substantial reduction in disease burden.
NB-UVB was well tolerated, with no significant adverse events reported during treatment. Three patients who did not respond to the combination strategy subsequently switched to ustekinumab.
The authors conclude that adjunctive NB-UVB phototherapy may represent a safe, accessible, and cost-conscious strategy to restore adalimumab efficacy in patients with secondary treatment failure. However, they emphasise that larger controlled studies are needed to confirm efficacy, clarify underlying mechanisms, and define the role of combination therapy in psoriasis management.
Reference
Tribolet de Abreu I et al. Narrowband-UVB may restore adalimumab efficacy in chronic plaque psoriasis patients: A prospective exploratory cohort study. Photochem Photobiol Sci. 2025;doi: 10.1007/s43630-025-00837-1
