SATURDAY

November 8

SESSION 2

10:15 – 10:30

ALEFACEPT: REDEFINING EFFICACY IN PSORIASIS

Michael Goldfarb

Amevive (alefacept) is a novel, human fusion protein that is effective in the treatment of psoriasis. The front end of Amevive is the extracellular portion of LFA-3 and the back end is part of the IgG molecule. The LFA-3 portion binds to CD-2, which is a molecule on T-cells. This binding reduces the ability of T-cells to be activated. Furthermore, natural killer cells attach to the IgG portion of Amevive and cause activated T-cells expressing CD-2 to disappear from the circulation (apoptosis). Because CD-2 is highly expressed on the surface of activated memory-effector T-cells, they are selectively depleted.

Amevive provides thorough clearing of psoriasis in a significant proportion of patients. These patients have a remission phase that averages seven months without additional therapy. Amevive is available intravenously and intramuscularly in the United States; the usual regimen is one injection weekly for 12 weeks. Because United States dermatologists are much more likely to use the intramuscular form, Biogen recently announced that they will provide only the i.m. Amevive in the U.S. market. Even though a reduction in CD-4 counts is expected because memory-effector T-cells are reduced, it is recommended to check CD-4 counts during Amevive therapy. Adverse events are similar to those found during placebo treatment. Because it is a human protein, Amevive rarely induces antibody responses. There have been no attributed malignancies, opportunistic infections, or cytokine release syndromes. Responses to vaccines are preserved during Amevive therapy. Psoriasis patients’ quality of life is significantly improved by Amevive therapy. Amevive is also beneficial for psoriatic arthritis.