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Treatment: Biologics
Efalizumab
FDA approved to
treat:
What’s involved in
taking efalizumab:
-
Patients give
themselves a weekly injection.
-
Efalizumab
requires continuous treatment, so patients prescribed efalizumab
should continue giving themselves an injection every week.
-
Screenings tests
for the hepatitis B virus and latent (not causing symptoms)
tuberculosis (TB) are conducted before efalizumab is prescribed.
-
When beginning
efalizumab therapy, patients should have their blood platelet
counts monitored frequently, usually monthly. With continuous
therapy and satisfactory platelet counts, monitoring can be done
less frequently.
How efalizumab
works:
Efalizumab blocks the activation of T cells, a type of white blood
cell that plays an important role in the body’s immune system. When
T cells are blocked, they cannot move into the skin to 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:
-
Sometimes rapid
results.
In clinical trials, patients have seen results as early as 2 weeks
after beginning treatment; however, most saw improvement after 4
to 6 weeks.
-
Skin clearing.
By week 12, between 20% and 35% of patients in a clinical trial
experienced a 75% or greater clearing. In a longer-term study, an
additional 20% had a 75% or greater clearing by week 24. Once
efalizumab is stopped, signs and symptoms of psoriasis usually
return.
Safety and side
effects:
Overall, efalizumab is well-tolerated. Side effects tend to be mild
to moderate. About 40% of patients experience headache, fever,
chills, nausea, vomiting, and muscle pain or tenderness after the
first few injections. By the third injection, the vast majority of
patients no longer experience these effects. In clinical trials,
these temporary side effects did not cause patients to stop taking
efalizumab.
Some patients have seen their psoriasis worsen. During clinical
trials, 19 out of 2,589 (0.7%) of the patients experienced this. For
most of these patients, worsening occurred after the efalizumab was
stopped. Patients should be closely monitored after stopping
efalizumab.
A few serious side effects have been reported, and some
patients receiving long-term efalizumab therapy for psoriasis have
developed psoriatic arthritis. The psoriatic arthritis appeared
while their psoriasis was under control. During clinical trials, one
patient experienced a tightness in the throat and stopped taking
efalizumab. Another patient’s blood platelets fell to a dangerously
low level about 3 ½ months after beginning efalizumab. Stopping
efalizumab and receiving treatment for the condition allowed the
patient’s platelet count to return to normal.
References:
Kipnis CD et al. “Biologic treatments for psoriasis.”
Journal of the American Academy of Dermatology. 2005
April;52(4):671-682
Leonardi
CL et al. “Extended
efalizumab therapy improves chronic plaque psoriasis: Results from a
randomized phase III trial.”
Journal of the American Academy of
Dermatology.
2005. March;52(3):425-433.
Myers WA et al. “New-onset, debilitating arthritis in psoriasis
patients receiving efalizumab.” Journal of Dermatological
Treatment. 2006. December;17(6):353-354.
An educational program brought to you by the American Academy of
Dermatology.
For an overview, visit
the AAD pamphlet
Psoriasis and Psoriatic Arthritis.
Supported by an educational donation
provided by Amgen and Wyeth.
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