title: The effect of topical corticosteroids in combination with alefacept on circulating T-cell subsets in psoriasis.
abstract: BACKGROUND
  Novel therapies against psoriasis are emerging. Alefacept is such a treatment. It selectively targets the memory effector population of T cells and thereby diminishes the psoriatic plaques. In some cases, however, the use of alefacept as a monotherapy is not sufficient.
  
  
  OBJECTIVE
  In the present study we investigate the safety and efficacy of adding topical steroids to alefacept treatment during the initial 4 weeks.
  
  
  METHODS
  Peripheral blood was obtained from all patients and the presence of specific T-cell subsets was assessed by flow cytometry. Fourteen patients were included and treated with 15 mg alefacept intramuscularly for a period of 12 weeks. Each of them was randomized to use either betamethasone-dipropionate cream or a vehicle cream during the first 4 weeks of the alefacept course.
  
  
  RESULTS
  Additional topical corticosteroid treatment during the first 4 weeks of alefacept treatment does not have a beneficial effect on the clinical efficacy. Marked changes were seen in the absolute cell counts of various of the analysed T-cell subsets in peripheral blood after 12 weeks of alefacept, either with or without additional local steroid application. The CD45RO+, CD8+CD45RO+, CD8+CD161+, CD4+CD25+, CD4+CLA+ and CD8+CLA+ populations showed a statistically significant decrease immediately after the treatment period. Further analysis revealed that the addition of local steroid therapy to alefacept results in marked decreases of all T-cell subsets analysed in this study, in contrast to the addition of the vehiculum only.
  
  
  CONCLUSIONS
  Alefacept selectively targets the CD45RO+ lymphocyte population, as well as some other subpopulations of lymphocytes. This effect is independent of the use of additional topical therapy during the first 4 weeks. The extent of the decrease, on the contrary, is dependent on the use of corticosteroids.
authors.affiliation: Department of Dermatologie, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. a.langewouters@derma.umcn.nl
authors.forename: Annechien M G
authors.initials: AM
authors.lastname: Langewouters
authors.forename: H Jorn
authors.initials: HJ
authors.lastname: Bovenschen
authors.forename: Elke M G J
authors.initials: EM
authors.lastname: De jong
authors.forename: Piet E J
authors.initials: PE
authors.lastname: Van Erp
authors.forename: Peter C M
authors.initials: PC
authors.lastname: Van De Kerkhof
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000077944:Alefacept; D000704:Analysis of Variance; D015703:Antigens, CD / Q000378:metabolism*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007273:Injections, Intramuscular; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy / Q000276:immunology* / Q000378:metabolism; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000494:pharmacology*; D012720:Severity of Illness Index; D016176:T-Lymphocyte Subsets / Q000187:drug effects* / Q000378:metabolism
chemical_list: D015703:Antigens, CD; D003879:Dermatologic Agents; D005938:Glucocorticoids; D011993:Recombinant Fusion Proteins; D000077944:Alefacept