Efalizumab in the treatment of psoriasis

Figures & data

Figure 1 Mode of action of efalizumab in psoriasis: According to a widely accepted working hypothesis, antigen-presenting dendritic cells of the epidermis transport yet unknown antigens to regional lymph nodes and present them to naïve T-cells. These respond by activation, proliferation, and maturation into effector T-cells, which patrol the body and leave circulation at the site of antigen contact. Subsequently, these cells migrate toward the epidermis and upon re-activation, release effector molecules, namely pro-inflammatory cytokines. Efalizumab interferes with this process at the LFA-1 dependent stages, namely activation of T-cells in lymph nodes (A), extravazation of circulating T-cells in inflammatory skin (B), and T-cell re-activation in the skin (C).

Table 1 Efficacy of efalizumab in the treatment of psoriasis (adapted from Boehncke et al 2006b)

Study	Agent	Study type	No. of patients	Dosing	Results	Comments
Gordon 2003	efalizumab	RDBPC	556	1 mg/kg weekly sc	PASI75 after 12 weeks: 27%
Gottlieb 2006	efalizumab	Open-label	339	2 mg/kg weekly sc with/without topical steroid	PASI75 after 9–12 weeks: ~40%	Maintenance study
Lebwohl 2003	efalizumab	RDBPC	597	1 vs 2 mg/kg weekly sc	PASI75 after 12 weeks: 22% vs 28%
Leonardi 2005	efalizumab	RDBPC	498	1 vs 2 mg/kg weekly sc	PASI75 after 12 weeks: 39% vs 27%
Menter 2005	efalizumab	RDBPC	556	1 mg/kg weekly sc	PASI75 after 12 weeks: 27%
Papp 2001	efalizumab	RDBPC	145	0.1 vs 0.3 mg/kg weekly iv	PASI after 56 days: 5% vs 25%	Dose-finding study

Abbreviations: RDBPC, randomized, double-blind, placebo-controlled; iv, intravenous; sc, subcutaneous.

Table 2 Safety of efalizumab

Very common	Flu-like symptoms after first/second injection
	Leukocytosis, lymphocytosis
Common	Rebound
	Exacerbation
	Arthralgia
Rare	Thrombocytopenia
	Transient neurophilic dermatosis
Very rare	Severe infections

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