A PubMed search using the term
alefacept was done through December of 2006 and articles reviewed. Abstracts concerning
alefacept presented at the meeting of the Annual meeting of the American Academy of Dermatology in 2004, 2005 and 2006 were reviewed. Attention was paid to
alefacept's safety profile,
off-label uses, and potential as part of combination
therapy for
psoriasis.
RESULTS: CONCLUSIONS: The utility of checking CD4 counts while administering
alefacept for 12 weeks is unclear. While no side effects have been linked to CD4 counts lower than 250/cc(3), due to the fact that in clinical trials
alefacept was discontinued when the CD4 count was lower than 250/cc(3), the effect of administration of
alefacept to patients with low CD4 counts is unknown.
Alefacept appears to be the safest
biologic therapy for the treatment of
psoriasis, safety that has been borne out in patients who have received as many as nine courses of
alefacept. Intramuscular
alefacept's consistent ability to decrease the
psoriasis area and severity index (PASI) scores in psoriatic patients is not as great as
phototherapy,
cyclosporine,
methotrexate or
tumor necrosis factor alpha blockers. Repeated courses of
alefacept are best used in patients who have previously responded to the medication, so that patients who have found
alefacept useful when grouped achieve higher and more consistent improvements of PASI scores with each successive course of
alefacept. A test that would identify likely responders would greatly increase the utility of the medication. While reports assessing the combination of
alefacept and narrow band ultraviolet B
phototherapy have only studied small numbers of patients ( approximately 60), the combination of
phototherapy and
alefacept appears synergistic and extremely effective with studied patients achieving PASI 75 in more than 75% of cases and thus merits further study. Combinations of
alefacept with
etanercept,
acitretin, and
methotrexate have been used anecdotally but effectively to treat recalcitrant
psoriasis. Reported effective
off-label uses of
alefacept include: generalized
lichen planus,
alopecia areata,
steroid-resistant or
steroid-dependent acute
graft-versus-host disease, scleroderma, nail
psoriasis, and palmoplantar
psoriasis.