title: Patterns of combination therapy with alefacept for the treatment of psoriasis in Canada in the AWARE study.
abstract: BACKGROUND
  Evidence from clinical trials supports the use of alefacept for the treatment of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities.
  
  
  OBJECTIVE
  AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, phase IV Canadian registry of psoriasis patients treated with alefacept.
  
  
  METHODS
  Patients with chronic plaque psoriasis were treated with at least one course of alefacept treatment followed by a period of at least 12 weeks off-treatment. The use of combination therapy with alefacept in a real-world population of psoriasis patients is presented here, including the types of psoriasis therapies received by patients at the time of enrolment, reasons for initiating alefacept, and discontinuation or dosage reduction of concomitant therapy.
  
  
  RESULTS
  The majority of patients were receiving other antipsoriatic therapies at the time of enrolment into the AWARE study, most commonly topical therapy, systemic agents, or phototherapy. Most patients were receiving monotherapy prior to the initiation of alefacept. There was little change in the use of topical therapies with alefacept at 24 weeks, whereas a substantial proportion of patients were able to reduce or discontinue concomitant systemic therapies and/or phototherapy. The use of combination therapy regimens was relatively consistent across the country and by age groups, although younger patients were prescribed systemic agents more often than older patients.
  
  
  CONCLUSIONS
  Alefacept is commonly added to other antipsoriatic therapies in a broad population of real-world chronic plaque psoriasis patients in Canada and may allow for dosage reduction or discontinuation of concomitant systemic agents or phototherapy.
authors.affiliation: Keystone Dermatology Institute, Edmonton, AB. gesearles@mac.com
authors.forename: Gordon
authors.initials: G
authors.lastname: Searles
authors.forename: Robert
authors.initials: R
authors.lastname: Bissonnette
authors.forename: Ian
authors.initials: I
authors.lastname: Landells
authors.forename: Neil H
authors.initials: NH
authors.lastname: Shear
authors.forename: Kim
authors.initials: K
authors.lastname: Papp
authors.forename: Harvey
authors.initials: H
authors.lastname: Lui
mesh_terms: D000293:Adolescent; D000328:Adult; D000077944:Alefacept; D002170:Canada / Q000453:epidemiology; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D009017:Morbidity / Q000639:trends; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077944:Alefacept