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Treatment: Biologics
Alefacept
FDA approved to treat:
What’s involved in taking alefacept:
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Intramuscular injection given in a doctor’s office
once a week for 12 weeks.
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Screenings tests for the hepatitis B virus and
latent (not causing symptoms) tuberculosis (TB) are conducted
before alefacept is prescribed.
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Patients taking alefacept are closely monitored and
must get regular blood tests to check their T cell (a type of
white blood cell) counts.
How alefacept works: Alefacept blocks the
activation of certain T cells, a type of white blood cell that plays
an important role in the body’s immune system. Blocking activation
of select T cells prevents the triggering of faulty signals that
cause the inflammation, redness, and other signs of psoriasis.
Effectiveness: Studies conducted to obtain
approval from the U.S. Food and Drug Administration (FDA) have
found:
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Skin clearing. About 20% of patients see a
75% or greater clearing, and approximately 40% achieve at least
50% clearing.
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Improvement gradual. Patients usually do not
see significant improvement for about 2 months. One study found
that 53% of patients who did not see a 50% or greater improvement
during the first 12-week course of alefacept saw a 50% or greater
improvement with a second course of alefacept.
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Long remission. For a small group of
patients, alefacept provides a long period of remission. The
average remission period in clinical trials for those who
responded was more than 7 months. Some remissions exceeded one
year. Once remission lapses, a repeat 12-week course of therapy
can be given if 12 weeks have passed since the last shot.
Safety and side effects: In clinical trials,
alefacept has a good overall safety profile. Most side effects are
mild and do not cause patients to stop taking alefacept. Common side
effects include chills, muscle aches, sore throat, nausea, and
dizziness. These occur most often after the first few injections and
tend to subside with subsequent shots.
A few more serious side effects have been reported.
In clinical trials, the most serious side effects were a significant
reduction in the number of white blood cells that fight infections
and serious infections that required hospitalization. Rare reports
of cancer have been made. In one study, of the 1,869 patients who
received alefacept, 43 were diagnosed with cancer. Most of the
cancers were nonmelanoma skin cancers.
References:
Kipnis CD et al. “Biologic treatments for psoriasis.” Journal of
the American Academy of Dermatology. 2005 April;52(4):671-682.
Krueger GG et al. “Development and use of alefacept to treat
psoriasis.” Journal of the American Academy of Dermatology.
2003. August;49(2 Suppl):S87-97.
Menter A et al. “The efficacy of multiple courses of alefacept in
patients with moderate to severe chronic plaque psoriasis.”
Journal of the American Academy of Dermatology. 2006.
January;54(1):61-63.
All content solely
developed by the American Academy of Dermatology
For an overview, visit
the AAD pamphlet
Psoriasis and Psoriatic Arthritis.
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