The added therapeutic efficacy and safety of alefacept in combination with other (systemic) anti-psoriatics in refractory psoriasis.
OBJECTIVE
Alefacept is a biologic treatment for psoriasis, with a selective effect on memory effector T cells. Few data are available on the combination of alefacept with either topical or systemic anti-psoriatics. We studied the effect of alefacept combination treatment on clinical disease severity scores and on circulating T-cell subsets.


METHODS
Twelve patients with moderate-to-severe psoriasis were included and treated with alefacept for a period of 12 weeks. Patients were allowed to continue the anti-psoriatic therapies they used prior to the study. Severity of disease and expression of T-cell markers CD4, CD8, CD45RA, CD45RO, CD94, CD161, CD25, and CLA were assessed at baseline and after treatment.


RESULTS
Seven of 12 included patients used a concomitant systemic therapy: either methotrexate (n = 4), acitretin (n = 2) or cyclosporine (n = 1). PASI reductions in this group after 12 and 24 weeks were 40% and 55%, respectively. Several lymphocyte subsets showed a reduction in circulating numbers. These decreases were independent of the use of an additional systemic psoriasis therapy.


CONCLUSIONS
The concomitant use of systemic anti-psoriatic medication in combination with alefacept has a noteworthy impact on efficacy results. No differences in circulating psoriasis-relevant T-cell populations between patients with or without an additional systemic treatment were seen.
Langewouters
Annechien M G
AM
Department of Dermatology, Radboud University Nijmegen, Nijmegen, The Netherlands. A.Langewouters@derma.umcn.nl
Van Erp
Piet E J
PE
De Jong
Elke M G J
EM
Van De Kerkhof
Peter C M
PC
D017255:Acitretin / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000077944:Alefacept; D016572:Cyclosporine / Q000008:administration & dosage; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011565:Psoriasis / Q000628:therapy*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D016896:Treatment Outcome
D003879:Dermatologic Agents; D011993:Recombinant Fusion Proteins; D016572:Cyclosporine; D000077944:Alefacept; D017255:Acitretin; D008727:Methotrexate