Summary of findings 3. Narrowband UVB phototherapy compared to medium‐dose UVA‐1 phototherapy (50 J/cm²) for morphea.

Narrowband UVB phototherapy compared to medium‐dose UVA‐1 phototherapy (50 J/cm2) for morphea
Patient or population: children and adults with active morphea (circumscribed morphea, linear scleroderma (with trunk/limb variant and head variant), generalised morphea, or mixed morphea). Setting: university hospital in Germany. Intervention: narrowband UVB phototherapy 5 times a week for a total of 40 treatment sessions. Comparison: medium‐dose UVA‐1 phototherapy (50 J/cm2) 5 times a week for a total of 40 treatment sessions.
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with medium‐dose UVA‐1 phototherapy (50 J/cm2)	Risk with Narrowband UVB phototherapy
Primary outcome: Global improvement of disease activity or damage assessed by a medical practitioner or by participants Assessed with: Modified Skin Score (MSS) Scale from: 0, no affected skin, to 42, extreme involvement in all areas Follow up: 8 weeks	The mean score (MSS) was 6.6	MD 1.70 lower (5.27 lower to 1.87 higher)	‐	35 (1 RCT)	⊕⊝⊝⊝ Low a
Primary outcome: Adverse effects Assessed with: number of participants who had mild tanning Follow up: 8 weeks	Individuals with morphea		RR 0.03 (0.00 to 0.42)	35 (1 RCT)	⊕⊝⊝⊝ Low b
	1000 per 1000	30 per 1000 (0 to 420)
Secondary outcome: Improvement of disease activity (skin softening) Assessed with: dermal density with a digital 20‐MHz ultrasound scanner (lower values indicate improvement of disease activity) Follow up: 8 weeks	The mean ultrasound score was 52.57	MD 17.78 higher (6.08 lower to 41.64 higher)	‐	28 (1 RCT)	⊕⊝⊝⊝ Low c
Secondary outcome: Improvement of disease damage ‐ not measured	See comment		‐	‐	‐	There was no measure of this outcome for this comparison.
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

^aDowngraded by 2 levels to low quality evidence. 1 level due to high risk of performance bias (blinding of participants and personnel), detection bias (blinding of outcome assessment) and reporting bias (selective reporting). Downgraded by 1 level due to small number of participants (less than 400 participants).

^bDowngraded by 2 levels to low quality evidence. 1 level due to high risk of performance bias (blinding of participants and personnel), detection bias (blinding of outcome assessment) and reporting bias (selective reporting). Downgraded by 1 level due to small number of events (less than 300 events).

^cDowngraded by 2 levels to low quality evidence. 1 level due to high risk of performance bias (blinding of participants and personnel), detection bias (blinding of outcome assessment) and reporting bias (selective reporting). Downgraded by 1 level due to small number of participants (less than 400 participants) and wide confidence interval (includes both null effect and appreciable benefit).