title: A randomized controlled study of combination therapy with alefacept and narrow band UVB phototherapy (UVB) for moderate to severe psoriasis: efficacy, onset, and duration of response.
abstract: BACKGROUND
  Alefacept is an effective intermittent treatment for psoriasis that can provide long-lasting remissions. Combination therapy with narrow-band ultraviolet B (nbUVB) phototherapy may enhance treatment outcomes and accelerate the onset of clinical response.
  
  
  OBJECTIVE
  To assess the efficacy of alefacept in combination with nbUVB phototherapy compared to alefacept alone in subjects with moderate to severe psoriasis.
  
  
  METHODS
  Ninety-eight adults with moderate to severe psoriasis were randomized to treatment with alefacept 15 mg intramuscularly (i.m.) once weekly for 12 weeks alone or in combination with three times weekly nbUVB treatments in this prospective, open-label, assessor-blinded, randomized, multicenter, parallel-group, 36-week study.
  
  
  RESULTS
  A statistically significantly greater proportion of subjects in the alefacept plus nbUVB arm achieved the primary endpoint of PASI 75 at week 16 compared to subjects in the alefacept alone arm (44.9% vs 22.5%, P=0.032). Secondary outcomes were also in favor of the alefacept plus nbUVB group, including the proportion of subjects achieving a Physician Global Assessment (PGA) score of clear or almost clear at any time during the study (59.2% vs 34.7%, P=0.026) and reduction in percent body surface area (BSA) involved with psoriasis at week 16 (13.4% vs 8.0%, P<0.001). The onset of clinical response was significantly faster in the combination therapy group compared to monotherapy (mean time to PASI 75: 82 vs 107 days, P=0.007). Both treatments were generally well tolerated.
  
  
  CONCLUSIONS
  Open-label, assessor-blinded study without a phototherapy-only treatment arm.
  
  
  CONCLUSIONS
  The addition of nbUVB to treatment with alefacept significantly enhanced and accelerated the clinical benefits of alefacept therapy and was generally safe and well-tolerated.
authors.affiliation: Photomedicine Institute, and Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada. harvey.lui@ubc.ca
authors.forename: Harvey
authors.initials: H
authors.lastname: Lui
authors.forename: Wayne
authors.initials: W
authors.lastname: Gulliver
authors.forename: Jerry
authors.initials: J
authors.lastname: Tan
authors.forename: Chih-Ho
authors.initials: CH
authors.lastname: Hong
authors.forename: Peter
authors.initials: P
authors.lastname: Hull
authors.forename: Neil H
authors.initials: NH
authors.lastname: Shear
authors.forename: Fran
authors.initials: F
authors.lastname: Paradiso-Hardy
authors.forename: Robert
authors.initials: R
authors.lastname: Bissonette
mesh_terms: D000328:Adult; D000368:Aged; D000077944:Alefacept; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy / Q000009:adverse effects; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011565:Psoriasis / Q000628:therapy*; D011788:Quality of Life; D011993:Recombinant Fusion Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000009:adverse effects; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D011993:Recombinant Fusion Proteins; D000077944:Alefacept