Psoriasis: Efalizumab recommendations

IMPORTANT NOTICE: This drug has been voluntary withdrawn as of April 8, 2009.

  • Indication: moderate to severe psoriasis
  • Dosing: 0.7 mg/kg first dose followed by 1.0 mg/kg/wk subcutaneously
  • Short-term response: 27% of patients achieve a PASI-75 at 3 mo
  • Long-term response: 44%-50% of patients achieved and maintained a PASI-75 response in a 3-y open-label study that only enrolled responders
  • Toxicities:
    • Flu-like symptoms frequently occur initially and generally disappear after the third wk of treatment
    • Thrombocytopenia, hemolytic anemia, pancytopenia, and peripheral demyelination have all been reported
  • Other issues:
    • Small percentage of patients may develop rebound or flare
    • Do not discontinue treatment abruptly unless essential
    • Not effective in psoriatic arthritis; flares and new-onset psoriatic arthritis have been reported in a subset of patients
  • Baseline monitoring: CBC
  • Ongoing monitoring:
    • CBCs monthly for the first 3 mo and at periodic intervals thereafter
    • LFT and a periodic history and physical examination are recommended while on treatment
  • Pregnancy category: C

Level of Evidence: I Strength of Recommendation: A

Read more on Efalizumab

Efalizumab is a recombinant humanized monoclonal IgG1 antibody directed against the CD11a subunit of lymphocyte function associated antigen-1 (LFA-1), that blocks LFA-1-mediated T-cell adhesion.  Blockade of LFA-1 interferes with T-lymphocyte activation, trafficking through blood vessels into inflamed skin and T-lymphocyte reactivation.103-106 Efalizumab is approved for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic agents or phototherapy.  Efalizumab is administered subcutaneously by the patient.  The recommended dose is 0.7mg/kg for the initiation dose followed by weekly 1 mg/kg doses thereafter.78  The results of several phase III trials demonstrate that after 12 weeks of treatment with efalizumab, between 27% and 39% of patients will have 75% improvement in their PASI score.64, 103-105, 107-115 After 24 weeks of continuous efalizumab therapy, 44% of patients achieved PASI-75.  Efalizumab maintains, and in some patients continues to improve, efficacy during long-term therapy.104, 110  In a three year, open-label, non-randomized trial of efalizumab responder patients eligible for maintenance therapy, that allowed for the concomitant use of UV phototherapy and topical corticosteroids, intent to treat analysis revealed that 44-50% of patients achieved and maintained at least a 75% reduction in PASI score from 6 months up to 36 months of ongoing efalizumab therapy.108, 109

Navigate section 1 of the psoriasis guideline: Biologics

Citation note

When referencing this guideline in a publication, please use the following citation: Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB,et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008 May;58(5):826-50. 

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