Background and Design: Efalizumab is a recombinant, humanized IgG1 monoclonal antibody used in the treatment of moderate to severe plaque psoriasis. Recently, because of the cases of progressive multifocal leukoencephalopathy, the marketing authorisation for efalizumab is suspended. This study is designed to examine the problems that we have faced in our patients that had to discontinue efalizumab and their responses to transition treatments. Material and Method: Patients (n=31) treated with efalizumab were evaluated in the study. After efalizumab was discontinued, patients received transitional treatments of cyclosporine (n=7), methotrexate (n=15), acitretin (n=4), narrowband UVB (n=4) and topical therapy (n=1) for 12 weeks. Efficacy of these treatments were assessed by using Psoriasis Area and Severity Index(PASI) scores and their affects on the occurrence of rebound and relapse. Results: Efalizumab was used for 9-161 weeks (mean, 31.8±33.3). Efalizumab-associated relapse or rebound was observed in 12 (38.7%) and 7(22.6%) of the patients at the end of 3-month of transition treatments. After 3-months of treatments, 71.4% of cyclosporine, 6.7% of methotrexate, 50% of acitretin and 75% of narrowband UVB users did not experience efalizumab-associated relapse or rebound events. According to our results, cyclosporine was the most effective systemic agent for preventing rebound.Conclusion: Our study shows that efalizumab discontinuation caused psoriasis worsening in more than half of our patients in three months. In light of our results, our study points out the fact that this disadvantage of biological agents should be considered in psoriasis patients and that conventional therapeutics should be used as the first step in the treatment of psoriasis.
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