Psoriasis treatment efalizumab

Autacoids Recurrent angioedema has been reported in a 63-year-old man with severe plaque psoriasis after efalizumab treatment for 15 weeks [233 ]. There was swelling of the periorbital area, cheek, tongue, and Ups, and after the next dose he developed the same sjmiptoms as weU as acute abdominal pain. Efalizumab was withdrawn and the sweUing and abdominal pain resolved within 3 weeks. 

Examples of antibodies in the market include trastuzumab (anti-HER2 monoclonal antibody), rituximab, natalizumab (x4-integiin antibody), abciximab, infiximab (targets TNF-a in Crohn s disease and rheumatoid arthritis), alemtuzumab, adalimumab (TNF-a antibody for the treatment of rheumatoid arthritis) and efalizumab (anti-CDlla monoclonal antibody for the treatment of psoriasis)Rituximab is a mouse/human chimeric anti-CD20 monoclonal antibody used for the treatment of various l)unphoid malignancies. As CE)20 antigen is found on the surface of... 

The population PK/PD of efalizumab were recently evaluated in patients with moderate to severe plaque psoriasis following SC administration of 1.0 and 2.0 mg/kg for 12 weeks [81-83]. Steady-state serum concentrations were achieved by four to eight weeks following administration of 1 and 2 mg/kg doses, respectively. At both doses, CDlla expression on T lymphocytes was reported to be maximally down-modulated. In addition, at doses of 1 and 2 mg/kg, >95 % of CDlla binding-sites were reported to be saturated at steady-state serum trough concentrations of 9 and 24 pg/mL, respectively. The improvement in PAS I scores was observed quickly, and efalizumab administration was reported to result in 60-70% improvement in PASI scores when compared to baseline after 12 weeks of treatment. The current recommended dose for efalizumab is a single 0.7 mg SC conditioning dose which is followed by weekly SC doses of 1 mg/kg. 

Gottlieb AB, Krueger JG, Wittkowski K, et al. Psoriasis as a model for T-cell-mediated disease immunobiologic and clinical effects of treatment with multiple doses of efalizumab, an anti-CD 1 la antibody. Arch Dermatol 2002 138 591-600. 

Efalizumab is a monoclonal antibody that inhibits the activation of T lymphocytes. It is licensed for severe plaque psoriasis resistant to other systemic treatment and phototherapy. Presumably, efalizumab works by inhibiting the inflammatory component of this type of psoriasis. 

Alefacept (Amevive, Biogen Idee) and Efalizumab (Reptiva, Xoma, Genentech, Serono), the two monoclonal antibodies, which block the activation of T cells, were hailed as major advances in the treatment of psoriasis. The sales of Reptiva were 112 million and 160 million and of Amevive were 48 and 15 million in 2005 and 2006 below initial sales forecasts mainly due to competition from TNF inhibitors [45]. The technical success of R D of non TNF biologicals for treatment of psoriasis has not translated into commercial success due to the large clinical data base and dominance of TNF antagonist products. 

Vestergaard ME, Kossard S, Murrell DF. Seborrhoeic keratoses appearing in sites of previous psoriasis plaques during treatment with efalizumab. Clin Exp Dermatol 2009 34(8) e564-6. 

Skin A localized papular rash or aggravation of psoriasis in an edematous or even pustular form are the two most commonly observed complications of treatment with efalizumab [223 ]. Efalizumab can cause exacerbation of psoriasis, including pustular, erythrodermic, and guttate subtypes [225 ], and rebound can also occur after... 

Puig L, Roe E, Garefa-Navarro X, Corella F, Alomar A. Efalizumab treatment of psoriasis vulgaris a cohort study in outpatient clinical practice. Clin Exp Dermatol 2009 34 469-75. 

Santos-Juanes J, Coto-Segura P, Saavedra J, Laviano S, Galache C. Development of familial benign chronic pemphigus in a patient undergoing treatment with efalizumab for psoriasis. J Eur Acad Dermatol Venereol 2009 23(5) 605-6. 

Martin B, Sanchez-Carazo JL, Perez-Ferriols A, Oliver V, Alegre V. Delayed generalized inflammatory psoriasis flare during efalizumab treatment. Br J Dermatol 2009 161(1) 212-3. 

Saraceno R, Scotto G, Chiricozzi A, Chimenti S. Urticaria associated with hyper-IgE in a patient with psoriasis undergoing treatment with efalizumab. Acta Derm Venereol 2009 89(4) 412-3. 

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