title: Efficacy outcomes in patients using alefacept in the AWARE study.
abstract: BACKGROUND
  Alefacept has demonstrated efficacy in clinical trials of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities such as phototherapy.
  
  
  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, either alone or added on to their existing antipsoriatic treatment regimen. Each course of alefacept was followed by a period of at least 12 weeks off treatment. Efficacy outcomes included physicians' and patients' assessments of response at week 18, as well as change in percent body surface area (BSA) involvement with psoriasis. The time to retreatment was assessed in patients receiving a second course of alefacept during at least 60 weeks of prospective follow-up.
  
  
  RESULTS
  The majority of patients received alefacept in combination with other antipsoriatic therapies. Physicians' and patients' assessments of response at 18 weeks showed that 42% and 41% of patients, respectively, had a "cleared to marked response" and a further 42% had a "moderate to some response." Among those patients whose psoriasis was moderately controlled or not controlled at baseline, 49 to 51% and 33 to 36%, respectively, improved to "cleared to marked response" at 18 weeks. A substantial shift in percent BSA involvement with psoriasis was observed at 18 weeks, with 55% of patients having a BSA involvement of < 10% at week 18 compared to only 20% having this level of BSA involvement at baseline. The mean time to retreatment among the 60% of patients who received a second course of alefacept was 19.3 weeks (range 2-47 weeks).
  
  
  CONCLUSIONS
  A single course of alefacept therapy improved outcomes in this broad population of real-world chronic plaque psoriasis patients.
  
  
  CONCLUSIONS
  The limitations of this study include its nonrandomized, noncontrolled, noncomparative design, which allowed multiple different treatment approaches across all patients. The rating scales used in this study have not been previously validated, and ranges were assigned to baseline control and response data that are not specifically defined. Clinicians did not receive specific training in using these scales; therefore, interrater variability could not be assessed.
authors.affiliation: Nexus Clinical Research, St. John's, NL. landells@nl.rogers.com
authors.forename: Ian
authors.initials: I
authors.lastname: Landells
authors.forename: Gordon
authors.initials: G
authors.lastname: Searles
authors.forename: Robert
authors.initials: R
authors.lastname: Bissonnette
authors.forename: Neil H
authors.initials: NH
authors.lastname: Shear
authors.forename: Ronald
authors.initials: R
authors.lastname: Vender
authors.forename: Harvey
authors.initials: H
authors.lastname: Lui
mesh_terms: D000077944:Alefacept; D002170:Canada / Q000453:epidemiology; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009017:Morbidity / Q000639:trends; D017060:Patient Satisfaction; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D011993:Recombinant Fusion Proteins; D000077944:Alefacept