Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

The Role of Narrowband UV-B Plus Alefacept Combination Therapy in the Treatment of Psoriasis

The Role of Narrowband UV-B Plus Alefacept Combination Therapy in the Treatment of Psoriasis In the August 2007 issue of the Archives, Legat et al1 described the accelerated and improved clearance of psoriasis when alefacept is combined with narrowband (NB) UV-B phototherapy. Because all patients in this study were treated with alefacept and with a randomly selected body half exposed to NB UV-B phototherapy, the question remained as to whether the improvement seen was greater than what can be achieved with NB UV-B monotherapy. We present data from 16 patients with chronic plaque psoriasis requiring systemic or phototherapy who were enrolled in an institutional review board approved, randomized, double-blind, placebo-controlled study comparing alefacept with NB UV-B vs NB UV-B alone for the treatment of psoriasis. Patient demographics and baseline disease characteristics are presented in the Table. All patients were treated with a standard course of NB UV-B (minimal erythema dosage, 3 times weekly for 12 weeks) and were randomized to receive either weekly intramuscular injections of alefacept, 15 mg, or placebo during the 12-week trial. The frequency of NB UV-B treatments could be decreased during the treatment period based on predetermined criteria. After the treatment period, patients were followed for 8 weeks to assess response duration. The primary end point used in the study was the percentage of decrease in PASI score from baseline after the 12-week period. Table. View LargeDownload Patient Demographics and Baseline Disease Characteristicsa Fifteen of 16 patients were included in analysis (1 patient receiving placebo and NB UV-B was dismissed owing to noncompliance before initiating treatment). At the conclusion of the 12-week trial, the reduction in Psoriasis Area Severity Index (PASI) scores was not significantly different between the 2 groups (P > .05) (Figure 1), with a substantial proportion of patients in both groups achieving a decrease in PASI score of 75% by the conclusion of the 12-week period (Figure 2). In regard to the partitioning of Asian American and African American patients into the group receiving placebo plus NB UV-B, this was unintentional because all patients were randomized. This stratification did not lead to any observable decreased response in the placebo group as might be expected, which attests further to the effect of NB UV-B compared with alefacept in these patients. As seen in Figure 1, there seemed to be a more rapid response in those receiving alefacept; however, this was not statistically significant (P > .05). Patients in both groups experienced similar duration of improvement after 8 weeks of observation. In regard to safety, the combination of alefacept and NB UV-B seemed to be well tolerated, with similar adverse events (mostly viral upper respiratory tract infections) as in those receiving placebo and NB UV-B; CD4+ T-cell counts remained above 200 cells/mm3 throughout the treatment period in both groups. Thus, the combination of alefacept plus NB UV-B did not lead to a more rapid or profound clearance of psoriasis compared with NB UV-B alone at the conclusion of the 12-week trial, nor did it lead to a greater duration of off-treatment response compared with placebo plus NB UV-B. Given its cost and adverse effect profile with little increase in efficacy, the addition of alefacept to NB UV-B phototherapy is likely not indicated. Figure 1. View LargeDownload Reduction from baseline Psoriasis Area Severity Index (PASI) score during the 12-week treatment period and the 8-week posttreatment observation period. No statistical difference in PASI scores was found at 12 weeks using the 2-factor, repeated-measures analysis of variance model (P > .05). NB indicates narrowband. Figure 2. View LargeDownload Proportions of patients achieving Psoriasis Area Severity Index (PASI) scores of 50% or 75% by the end of the 12-week treatment period. NB indicates narrowband Correspondence: Dr Jacobe, Department of Dermatology, University of Texas–Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390-9069 (heidi.jacobe@utsouthwestern.edu). Financial Disclosure: None reported. Funding/Support: Biogen/IDEC provided alefacept and NB UVB for this study. References 1. Legat FJHofer AWackernagel A et al. Narrowband UV-B phototherapy, alefacept, and clearance of psoriasis. Arch Dermatol 2007;143 (8) 1016- 1022PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

The Role of Narrowband UV-B Plus Alefacept Combination Therapy in the Treatment of Psoriasis

Loading next page...
 
/lp/american-medical-association/the-role-of-narrowband-uv-b-plus-alefacept-combination-therapy-in-the-QEBP34iwtf
Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.144.8.1067
Publisher site
See Article on Publisher Site

Abstract

In the August 2007 issue of the Archives, Legat et al1 described the accelerated and improved clearance of psoriasis when alefacept is combined with narrowband (NB) UV-B phototherapy. Because all patients in this study were treated with alefacept and with a randomly selected body half exposed to NB UV-B phototherapy, the question remained as to whether the improvement seen was greater than what can be achieved with NB UV-B monotherapy. We present data from 16 patients with chronic plaque psoriasis requiring systemic or phototherapy who were enrolled in an institutional review board approved, randomized, double-blind, placebo-controlled study comparing alefacept with NB UV-B vs NB UV-B alone for the treatment of psoriasis. Patient demographics and baseline disease characteristics are presented in the Table. All patients were treated with a standard course of NB UV-B (minimal erythema dosage, 3 times weekly for 12 weeks) and were randomized to receive either weekly intramuscular injections of alefacept, 15 mg, or placebo during the 12-week trial. The frequency of NB UV-B treatments could be decreased during the treatment period based on predetermined criteria. After the treatment period, patients were followed for 8 weeks to assess response duration. The primary end point used in the study was the percentage of decrease in PASI score from baseline after the 12-week period. Table. View LargeDownload Patient Demographics and Baseline Disease Characteristicsa Fifteen of 16 patients were included in analysis (1 patient receiving placebo and NB UV-B was dismissed owing to noncompliance before initiating treatment). At the conclusion of the 12-week trial, the reduction in Psoriasis Area Severity Index (PASI) scores was not significantly different between the 2 groups (P > .05) (Figure 1), with a substantial proportion of patients in both groups achieving a decrease in PASI score of 75% by the conclusion of the 12-week period (Figure 2). In regard to the partitioning of Asian American and African American patients into the group receiving placebo plus NB UV-B, this was unintentional because all patients were randomized. This stratification did not lead to any observable decreased response in the placebo group as might be expected, which attests further to the effect of NB UV-B compared with alefacept in these patients. As seen in Figure 1, there seemed to be a more rapid response in those receiving alefacept; however, this was not statistically significant (P > .05). Patients in both groups experienced similar duration of improvement after 8 weeks of observation. In regard to safety, the combination of alefacept and NB UV-B seemed to be well tolerated, with similar adverse events (mostly viral upper respiratory tract infections) as in those receiving placebo and NB UV-B; CD4+ T-cell counts remained above 200 cells/mm3 throughout the treatment period in both groups. Thus, the combination of alefacept plus NB UV-B did not lead to a more rapid or profound clearance of psoriasis compared with NB UV-B alone at the conclusion of the 12-week trial, nor did it lead to a greater duration of off-treatment response compared with placebo plus NB UV-B. Given its cost and adverse effect profile with little increase in efficacy, the addition of alefacept to NB UV-B phototherapy is likely not indicated. Figure 1. View LargeDownload Reduction from baseline Psoriasis Area Severity Index (PASI) score during the 12-week treatment period and the 8-week posttreatment observation period. No statistical difference in PASI scores was found at 12 weeks using the 2-factor, repeated-measures analysis of variance model (P > .05). NB indicates narrowband. Figure 2. View LargeDownload Proportions of patients achieving Psoriasis Area Severity Index (PASI) scores of 50% or 75% by the end of the 12-week treatment period. NB indicates narrowband Correspondence: Dr Jacobe, Department of Dermatology, University of Texas–Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390-9069 (heidi.jacobe@utsouthwestern.edu). Financial Disclosure: None reported. Funding/Support: Biogen/IDEC provided alefacept and NB UVB for this study. References 1. Legat FJHofer AWackernagel A et al. Narrowband UV-B phototherapy, alefacept, and clearance of psoriasis. Arch Dermatol 2007;143 (8) 1016- 1022PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Aug 18, 2008

Keywords: combined modality therapy,psoriasis,ultraviolet b radiation,alefacept

References