Recombinant protein an effective and sustained treatment
for psoriasis
A recombinant protein, alefacept, is an effective
treatment for chronic plaque psoriasis, according to a new study. It is
also well tolerated and non-immunogenic.
Dr Charles Ellis, University of Michigan Medical
School, United States, and colleagues say that in psoriatic lesions, most
lymphocytes are memory effector T-cells. Alefacept inhibits the activation
of T-lymphocytes and modifies the inflammatory process.
In a multi-centre, double-blind study, 229 patients,
aged between 18 and 70 years, were randomly assigned to receive one of
three doses of alefacept or placebo. Alefacept was administered intravenously
once a week for 12 weeks and patients were followed-up for a further 12
weeks.
The researchers found that during treatment, patients
receiving alefacept had a greater decrease in psoriasis area-and-severity
index (a measure combining the scores for the degree of erythema, hardening
of tissue, scaling of skin and percentage of body-surface area affected)
than those receiving placebo.
The researchers say that improvement with alefacept
therapy was sustained after treatment. At two and 12 weeks after treatment,
the proportion of patients who had a 50 per cent or greater reduction
in their base-line scores on the psoriasis area-and-severity index was
higher in all three alefacept groups than in the placebo group.
Twelve weeks after completing treatment, 28 of the
118 patients who had received alefacept alone were clear or almost clear
of psoriasis compared with three patients in the placebo group (who had
also received additional systemic therapy).
Of the 28 patients treated with alefacept, 26 participated
in subsequent alefacept studies. The median time between receiving their
final dose of alefacept in the first study and the initiation of retreatment
was 306 days. The researchers comment: “This period of remission was substantially
longer than that which would be expected if systemic therapy with methotrexate
or ciclosporin were adminstered.”
The study is published in The New England Journal
of Medicine (2001;345:248).
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