Clinical efficacy and safety profile of handheld narrow band ultraviolet B device therapy in vitiligo - Systematic review and meta-analysis.

Background Handheld narrowband ultraviolet B (NB-UVB) device is a portable, home-based, patient-friendly equipment used in vitiligo. It is a newer promising treatment that lacks generalised consensus due to heterogenicity among studies. Objective To determine the clinical efficacy and safety profile of handheld NB-UVB devices in the treatment of vitiligo. Methods Following the PRISMA guidelines and using appropriate keywords, the Embase, PubMed and Scopus databases were searched on 28 November 2023. Data on the proportion of patients with a percentage of re-pigmentation and toxicity were extracted from the included studies. Random effects and fixed model were utilised to generate pooled estimates via meta-analysis. Results Out of 250 articles, 13 studies (557 patients) were included. The extent of repigmentation achieved over a median duration of 6 months (range 3-12 months) was quantified to be > 25%, > 50%, and >75 % in 63.6% (95% CI: 51.0-75.3%), 40.8% (95% CI: 30.4-51.6%) and 15.4% (95% CI: 7.6-25.3%) of patients respectively. After 12 weeks of treatment, the proportions of patients achieving > 25%, > 50%, and >75% re-pigmentation were 31.1% (95% CI: 9.6-58.3%), 12.9% (95% CI: 3.1-28.1%) and 6.5% (95% CI: 1.7-14.1%), respectively. Similarly, at 24 weeks, these proportions were 53.2% (95% CI: 24.5-80.7%), 36.7% (95% CI: 15.8-60.5%), and 11.1% (95% CI: 2.9-23.7%). Minimal erythema dose (MED) calculation-based therapy was not significantly better than therapy given without MED calculation (p = 0.43). The studies with only stable vitiligo patients did not achieve significantly greater > 25% (p = 0.06), > 50% (p = 0.80), and > 75% (p = 0.25) re-pigmentation compared to the studies that also included active or slowly progressive vitiligo. Three sessions per week resulted in significantly higher > 50% (p < 0.01) and > 75% (p = 0.01) re-pigmentation. Totally, 11.3% (38/334) of patients showed no response to therapy. The most commonly reported adverse event was erythema in 33.4% (95% CI: 19.3-49.2%) of patients, with grade 3 and 4 erythema in 27 and 15 patients, respectively. Other adverse events included pruritus, burning, hyperpigmentation, dryness, and blister formation observed in 22.1%, 16.4%, 19.1%, 9.8%, and 9.7% of patients, respectively. Conclusion Handheld NB-UVB portable home-based devices are an efficacious and safe treatment option in vitiligo patients even without MED calculation, when the treatment frequency is three to four sessions per week.