Clinical Experience:
- Alefacept experience in clinical trials and in practice is in moderate to severe psoriasis.
- Early clinical experience suggests that the optimal use of Alefacept may involve two courses.
- Some patients have shown benefit from receiving longer courses of therapy (treat to clear) than mandated by the FDA in clinical trials (12 weeks).
- A washout period is not required when transitioning a patient to Alefacept from another systemic therapy.
- While the patient is on Alefacept, the dose of the other therapy can be titrated down and then discontinued.
- Combination therapy has also been used to speed up the onset of Alefacept and provide even longer remissions.
Indications:
Treatment of patients with moderate to severe chronic plaque psoriasis who are candidates for phototherapy or systemic therapy
Contraindication
- Should not be administered to patients with known hypersensitivity to alefacept or any of the components of the formulation
- Patients with a clinically important infection, including HIV
Patient Profile:
- Moderate to severe disease (>10% of body surface area involved)
- Patients who are candidates for phototherapy or systemic therapy
- Those who are uncomfortable with or intolerant to the side effects of other therapies
- Patients who are dissatisfied or are having inadequate response to their current treatment
- < 10% of body surface area involved: patients whose psoriasis has a very significant impact on their Quality of Life
Dosing:
- Alefacept 15mg im. once per week
- The standard treatment period is twelve, once-weekly injections, followed by a twelve week treatment-free period.
- In trials, patients received weekly doses (12 weeks) of Alefacept or placebo and were monitored for an additional 12 weeks without treatment. A second 12 week course was initiated if it was determined that the patient would benefit from further clearing.
- Clinical impressions have indicated that increasing the dosing period beyond 12 weeks (treat to clear) results in longer remissions
- Patients should be administered at least two courses before deciding on next steps
Cost of Treatment:
- While all biological drugs are associated with a higher initial cost, the benefits of Alefacept in terms of safety, efficacy, remission and improvement in QOL need to be weighed against the other traditional therapies that have been used in the past.
- Most patients with private insurance have coverage for Alefacept.
- Remissions or ‘treatment –free’ periods with Alefacept lower the average cost for this medication. Costs should be considered over a three year period when making comparisons.
