Open label trial of alefacept in palmoplantar pustular psoriasis.
BACKGROUND
Palmoplantar pustular psoriasis (PPP) is difficult to treat. We assessed the effectiveness of alefacept in PPP and the safety of a 30 mg/week dose.


METHODS
Fifteen individuals with PPP were started on 15 mg/week intramuscularly (IM) alefacept. Efficacy was measured by the PPP severity instrument (PSI). Treatment was continued for 16 weeks, and the alefacept dose was increased to 30 mg/week IM at week 9 if the PSI did not decrease by at least 25%. Other outcomes included physician's global assessment (PGA), reported adverse events and CD4+ T-lymphocyte counts. Clinical response was observed for 12 weeks after the last injection.


RESULTS
The severity of PPP improved in both the PSI and the PGA (p<0.0001 and p = 0.0009, respectively). Much of the improvement occurred after 10 weeks of therapy. Nail severity scores improved (p = 0.0003). CD4+ counts decreased, but all remained >250 cells/mm3. There were no severe adverse effects or discontinuations due to adverse events.


CONCLUSIONS
Alefacept in doses up to 30 mg/week was well tolerated in patients with PPP and appeared to have some efficacy. The use of concomitant therapy, the lack of a comparator, and the small sample size are limitations of the study.
Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
David
D
Carr
Mark G
MG
Tusa
Christie L
CL
Carroll
Daniel J
DJ
Pearce
Fabian
F
Camacho
Mandeep
M
Kaur
Christina
C
Cook
Joy
J
Willard
Ann
A
McCarty
Alan B
AB
Fleischer
Clive M
CM
Liu
Bernard S
BS
Goffe
Steven R
SR
Feldman
D000328:Adult; D000368:Aged; D000077944:Alefacept; D015331:Cohort Studies; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005533:Foot Dermatoses / Q000188:drug therapy* / Q000473:pathology; D006229:Hand Dermatoses / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*
D003879:Dermatologic Agents; D011993:Recombinant Fusion Proteins; D000077944:Alefacept