An RCT has compared PUVA, 2-5 times weekly, plus alfa interferon, 9 MU three times weekly, with alfa interferon plus acitretin, 25-50 mg/day, in 98 patients (maximum duration of treatment in both groups 48 weeks).30 In 82 patients with stage I/II diseases, CR rates were 70% in the PUVA/interferon group compared with 38% in the interferon/acitretin group (P<0-05). Responses were assessed on the basis of clinical observation only. Time to response was 18-6 weeks in the PUVA/interferon, compared with 21-8 weeks in the interferon/acitretin group (P = 0-026) but no data on duration of response was reported. Total cumulative doses of alfa interferon were similar in both groups.

An open study of 69 patients compared PUVA and acitretin with PUVA alone in mycosis fungoides.31 This showed that the cumulative dose of PUVA to achieve a CR was lower in the combined-treatment group, although the overall CR was similar in the two groups (73% and 72%, respectively). No data on duration of response was documented.31

Phase I and II studies of PUVA (three times weekly) combined with variable doses of alfa interferon (maximum tolerated dose of 12 MU/m2 three times weekly) in 39 patients with mycosis fungoides (all stages) and Sezary syndrome have reported an overall response (OR) rate of 100%: 62% showing CR and 28% PR. (CR rates were 79% in stage IB patients, 80% in IIA patients, 33% in stage IIB patients, 63% in stage III patients and 40% in stage IVA patients).32 PUVA was continued as a maintenance therapy indefinitely while alfa interferon was continued for 2 years or until disease progression or withdrawal due to adverse effects. The median response duration was 28 months, with a median survival of 62 months.32

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