Alefacept

Alefacept is a human recombinant integrin LFA3-IgG fusion protein that binds to the CD2 receptor thus blocking T-cell activation. 

For the topical treatment of some chronic inflammatory skin diseases (like atopic dermatitis) immunosuppressive macrolides (like TRL and pimecrolimus) that permeate the inflamed epidermis are of benefit for patients. Severe side effects comparable to those after systemic application of TRL in transplanted patients (see above) have not been observed so far. For the treatment of psoriasis vulgaris these drugs are less effective. The CD2 antagonist alefacept may be a suitable alternative to allergic reactions. 

Systemic therapies are seldom used for mild to moderate psoriasis, and are generally reserved for patients with moderate to severe psoriasis.17 29 Oral agents include sulfasalazine, acitretin, methotrexate, cyclosporine, mycophenolate mofetil, azathioprine, tacrolimus, and hydroxyurea. Parenteral agents include the biologic response modifiers alefacept, efalizumab, etanercept, infliximab, and many others, currently at various stages of research or approval for psoriasis. 

Alefacept (Amevive) is a dimeric fusion protein that binds to CD2 on T cells to inhibit cutaneous T-cell activation and proliferation. It also produces a dose-dependent decrease in circulating total lymphocytes. Alefacept is approved for treatment of moderate to severe plaque psoriasis and is also effective for treatment of psoriatic arthritis. Significant response is usually achieved after about 3 months of therapy. The recommended dose is 15 mg intramuscularly once weekly for 12 weeks. Adverse effects are mild and include pharyngitis, flu-like symptoms, chills, dizziness, nausea, headache, injection site pain and inflammation, and nonspecific infection. 

Gottlieb, A. et al., Impact of a 12-week course of alefacept therapy on primary and secondary immune responses in psoriasis patients, J. Eur. Acad. Dermatol. Venereol., 15 (Suppl. 2), 242 (Abst. P24-21), 2001. 

Biogen IDEC. Alefacept (Amevive ) Product Insert, 2005. 

Weinberg JM et al Biologic therapy for psoriasis An update on the tumor necrosis factor inhibitors infliximab, etanercept, and adalimumab, and the T-cell-targeted therapies efalizumab and alefacept. J Drugs Dermatol 2005 4 544. [PMID 16167412]... 

Biologic agents useful in treating adult patients with moderate to severe chronic plaque psoriasis include the T-cell modulators alefacept and efalizumab, and the TNF-a inhibitors etanercept, infliximab, and adalimumab. TNF-a inhibitors are also discussed in Chapter 55. 

Alefacept (Amevive) is an immunosuppressive dimeric fusion protein that consists of the extracellular CD2-binding portion of the human leukocyte function antigen-3 linked to the Fc portion of human IgG]. Alefacept interferes with lymphocyte... 

Acitretin (Soriatane) Acyclovir (Zovirax) Alefacept (Amevive) Anthralin (Anthra-Derm) Amphotericin B (Amphocin) Bacitracin, Topical (Baciguent)... 

Graves JE, Nunley K, Heffeman MP. 2007. Off-label uses of biologies in dermatology Rituximab, omalizumab, infliximab, etanercept, adalimumab, efalizumab and alefacept. J Am Acad Dermatol. 56 e55-e79. 

Three intact conjugated unlabeled mAbs alefacept (+ protein), etanercept (+ protein), gemtuzumab ozogamicin (+ toxin). 

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