CHICAGO — Evidence is mounting that biologic therapies such as alefacept and efalizumab can successfully treat palmoplantar pustular psoriasis.
Preliminary data from a pilot study of 15 patients at two sites showed a 16-week course of alefacept (Amevive), including 8 weeks of alefacept 30 mg once weekly, resulted in substantial improvements in clinical outcomes, Daniel Pearce, M.D., reported in a poster at the American Academy of Dermatology's Academy 2005 meeting.
The mean improvement in palmoplantar psoriasis severity instrument (PPSI) scores was 18% among nine patients at site A and 45% among six patients at site B.
Physician's global assessment (PGA) of palmoplantar psoriasis improved significantly at site A from 2.3 at week 4 to 1.8 at week 28, and improved at site B from 2.4 at week 4 to 2.0 at week 16.
Patients in this study were injected intramuscularly with 15 mg/wk of alefacept for 16 weeks, compared with the recommended 12-week course for adult psoriasis patients.
The dose was increased in the majority of patients to 30 mg/wk at 8 weeks due to a limited response.
All patients were allowed to remain on methotrexate 25 mg/wk or less or acitretin 50 mg/day or less during the trial, sponsored by Biogen Idec Inc., which markets Amevive and is headquartered in Cambridge, Mass.
There was no plateau in response for PPSI and PGA scores at week 16, suggesting that the longer treatment may possibly offer greater benefit for some patients, reported Dr. Pearce of the Center for Dermatology Research at Wake Forest University, Winston-Salem, N.C.
CD4 T-cell counts were predictably reduced by alefacept. But no patient had CD4 T-cell counts less than 250 cells/mm
In a separate poster that was reported at the same meeting, a 50-year-old patient remained clear of palmoplantar pustular psoriasis 11 months after beginning treatment with efalizumab (Raptiva).
The patient remains on continuous efalizumab therapy and is currently able to walk without pain as well as being able to use her hands again, reported Loretta A. Jones, a nurse practitioner at the Abilene (Texas) Dermatology and Skin Surgery Center.
A response was observed in 1 month of initiating subcutaneous efalizumab 1 mg/kg per week, and the patient was asymptomatic after 5 months.
There were neither any flares nor any adverse events attributed to the drug, according to the poster, which was developed with support from Genentech Inc. of South San Francisco, Calif., which markets Raptiva.