EfalizumabA Review of its Use in the Management of Chronic Moderate-to-Severe Plaque Psoriasis

摘要

Efalizumab (Raptiva~R) is a recombinant, humanized, monoclonal antibody that targets CD11a, the alpha-subunit ofthe heterodimeric lymphocyte surface protein lymphocyte function-associated antigen-1 (LFA-1). It is approved for the treatment of adult patients (aged > =18 years) with chronic moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy (in the US), or who have failed to respond to, have a contraindication to, or are intolerant of, other systemic therapies, including cyclosporine (ciclosporin), methotre-xate, and psoralen plus UVA photochemotherapy (in the EU).Weekly subcutaneous injections of efalizumab are effective and generally well tolerated in the treatment of adults with chronic moderate-to-severe plaque psoriasis, including high-need individuals (i.e. those for whom at least two currently available systemic therapies are unsuitable due to lack of efficacy, intolerance, or contraindication), and patients with difficult-to-treat forms of the disease affecting the scalp, hands/feet, or nails. Clinical improvements are maintained, with no evidence of cumulative or end-organ toxicity, during continuous administration of efalizumab for up to 3 years; 4-, 5-, and 7-year safety data are being collected. The therapeutic profile of efalizumab cannot be directly compared with that of other antipsoriasis agents because of a lack of head-to-head comparative studies. Nonetheless, a considerable body of data indicates that efalizumab is an appropriate alternative to other biologic or nonbiologic therapies for the treatment of chronic moderate-to-severe plaque psoriasis that, additionally, offers the potential convenience of self-injection at home.