title: Transitioning patients from efalizumab to alternative psoriasis therapies: findings from an open-label, multicenter, Phase IIIb study.
abstract: BACKGROUND
  Rebound in psoriasis is, by definition, a rapid worsening of disease following the discontinuation of therapy for psoriasis; it occurs following the abrupt discontinuation of many therapies. To prevent rebound on discontinuation of efalizumab, this study evaluated the effectiveness of transitioning patients to an alternative psoriasis therapy.
  
  
  METHODS
  Patients (n = 130) received subcutaneous efalizumab 1 mg/kg/week for 12 weeks. Efalizumab was discontinued at 12 weeks; patients were evaluated for improvement from baseline in the Psoriasis Area and Severity Index (PASI) and a 12-week transition period was begun. Patients who achieved PASI improvement of 75% or more (PASI-75) at week 12 of efalizumab treatment were observed during the transition period and treated only if psoriasis recurred. Patients who did not attain PASI-75 at week 12 of efalizumab treatment were immediately transitioned to an alternative psoriasis therapy at the physician's discretion. All patients were evaluated for signs of rebound following efalizumab discontinuation.
  
  
  RESULTS
  Rebound was not observed in any PASI-75 responder (n = 46). Rebound was observed in two of 32 patients who achieved between PASI-50 and PASI-75, and was more common in nonresponders (14/49). Rebound was observed in none of the eight patients treated with cyclosporine and in two of the 12 patients treated with methotrexate during the transition period.
  
  
  CONCLUSIONS
  These results suggest that efalizumab-responsive patients are less likely to experience rebound than nonresponders and may not require treatment until disease recurrence following efalizumab discontinuation. Efalizumab nonresponders are at higher risk of developing rebound and thus should be considered for transition to an appropriate psoriasis therapy immediately following efalizumab discontinuation.
authors.affiliation: Baylor University Medical Center, Dallas, Texas, USA. amresearch@texasderm.com
authors.forename: Alan
authors.initials: A
authors.lastname: Menter
authors.forename: Tiffani K
authors.initials: TK
authors.lastname: Hamilton
authors.forename: Darryl P
authors.initials: DP
authors.lastname: Toth
authors.forename: Hoi M
authors.initials: HM
authors.lastname: Leung
authors.forename: Graham
authors.initials: G
authors.lastname: Wetherill
authors.forename: Brian
authors.initials: B
authors.lastname: Hennessey
authors.forename: Marvin
authors.initials: M
authors.lastname: Garovoy
authors.forename: Paul
authors.initials: P
authors.lastname: Kwon
authors.forename: David M
authors.initials: DM
authors.lastname: Pariser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D011701:PUVA Therapy; D011565:Psoriasis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; C472181:efalizumab