The Use of Alefacept in the Treatment of Psoriasis

Psoriasis is a chronic, incurable disease with associated morbidity and a profound negative impact on the quality of life of affected patients. Current systemic therapies for moderate to severe psoriasis are effective but have potential for side effects, and may require chronic, continual use, as most are suppressive in nature. For example, cyclosporine is associated with hypertension, with functional and structural damage to the kidneys. Methotrexate can result in hepatotoxicity with psoriasis and requires liver biopsy for monitoring. Long-term use of psoralen plus ultraviolet A (PUVA) is associated with higher risk of nonmelanoma and possibly melanoma skin cancer. Given the chronic nature of psoriasis and the limitation of existing therapies, there is an unmet need for therapies with fewer side effects and durable remissions. 1,2 There has been considerable progress in understanding the pathophysiology of psoriasis and this has resulted in the development of targeted biologic therapies. Biologic agents are emerging that target pathogenic T-cells directly (i.e., reduction in pathogenic T-cells, inhibition of T-cell activation, prevention of T-cell trafficking) or target pathogenic cytokines [e.g., tumor necrosis factor (TNF)-a], resulting in favorable efficacy and improved safety in comparison with the currently available systemic therapies. 2