Narrowband UV-B phototherapy, alefacept, and clearance of psoriasis.
OBJECTIVE
To determine whether the addition of 311-nm narrowband UV-B (NB UV-B) phototherapy accelerates and improves the therapeutic efficacy of alefacept, a biological antipsoriatic drug approved for the treatment of moderate to severe psoriasis.


METHODS
Randomized half-body comparison study.


METHODS
Ambulatory section of a university hospital photodermatology unit.


METHODS
Fourteen patients with moderate to severe psoriasis.


METHODS
All patients were treated with 7.5 mg of intravenous alefacept once weekly for 12 weeks. Three times each week, a randomly selected body half (left or right) was treated with NB UV-B light until complete remission, defined as a reduction in the Psoriasis Area Severity Index (PASI) to 3 or lower, was achieved on the irradiated body half.


METHODS
Modified PASI, self-assessed visual analogue scale rating of skin lesions, and self-assessed therapeutic efficacy.


RESULTS
After 12 weeks of treatment, the mean PASIs on UV-irradiated and nonirradiated body halves were significantly reduced by 81% and 62%, respectively (P < .001). From week 3 to week 12, the mean PASI was significantly lower on UV-irradiated body halves than on nonirradiated body halves (P < .001). At week 12, PASI reductions of greater than 75% had been achieved significantly more often on UV-irradiated body halves (86%, 12 of 14) than on nonirradiated body halves (43%, 6 of 14), and complete remission had been achieved significantly more often on UV-irradiated body halves (43%, 6 of 14) than on nonirradiated body halves (0 of 14) (McNemar test P = .03).


CONCLUSIONS
In this randomized half-side comparison of alefacept with and without phototherapy for psoriasis, alefacept with NB UV-B phototherapy accelerated and improved the clearance of psoriasis. This suggests a promising future for this combination as antipsoriatic therapy.
Legat
Franz J
FJ
Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036 Graz, Austria.
Hofer
Angelika
A
Wackernagel
Alexandra
A
Salmhofer
Wolfgang
W
Quehenberger
Franz
F
Kerl
Helmut
H
Wolf
Peter
P
D000328:Adult; D000077944:Alefacept; D003131:Combined Modality Therapy; D003879:Dermatologic Agents / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D016896:Treatment Outcome; D014467:Ultraviolet Therapy
D003879:Dermatologic Agents; D011993:Recombinant Fusion Proteins; D000077944:Alefacept