Alefacept and Ultraviolet B
Combination Therapy for Psoriasis
Title: An open-label study of alefacept plus
ultraviolet B light as combination therapy for chronic plaque
psoriasis.
Authors: Ortonne JP et al.
Publication: J Eur Acad Dermatol Venereol. 2005
Sep;19(5):556-63.
In clinical trials of psoriasis with the drug alefacept (a human
LFA-3/IgG fusion protein), it was discovered that clinical improvement
and prolonged remission of psoriasis were correlated with decreased
level of circulating memory T cells. Reduction in T cells in psoriatic
lesion has also been observed following ultraviolet B (UVB) light
therapy.
Because alefacept and UVB target T cells in different ways, the
authors wanted to see whether combining the two would lead to
greater efficacy in treating chronic psoriasis. To do this, they
conducted an open-label, parallel-group studies in France using
narrowband UVB and the United States using broadband UVB.
Sixty patients (30 in France and 30 in the US) were given 12
weekly injections of 15 mg. alefacept and were divided into 3
groups:
- No UVB
- 6-week UVB treatment
- 12-week UVB treatment
The 12-week treatment period was followed by a 12-week follow
up period, with visits every 2 to 4 weeks during the follow up.
The authors reported that alefacept was well tolerated when either
given by itself or in combination with UVB therapy. There was
no evidence of increased sensitivity to light or side effects
when given in combination.
The authors found that in either location (with narrowband or
broadband UVB), the combination alefacept/UVB treatment provided
overall higher response rate and more rapid response compared
to alefacept by itself. In patients with 50% or greater reduction
in PASI index, those who received alefacept/UVB combination treatment
maintained this result throughout the follow-up phase without
any further psoriasis treatment.
In conclusion, the author noted that the combination of alefacept
and UVB treatment for chronic plaque psoriasis was well tolerated
and had better and more rapid response than alefacept alone.
