Efalizumab in the treatment of chronic plaque psoriasis: experiences from the largest psoriasis treatment centre in Denmark

Abstract

About 20-30% of patients with chronic plaque psoriasis have severe forms of the disease and require systemic treatment. The long-term use of conventional systemic therapies is limited by toxicity, and many patients are resistant to these treatments. New biological agents, such as efalizumab and infliximab, offer a more targeted approach than conventional therapies and are more suitable for long-term, continuous treatment. At our hospital, we started treating patients with efalizumab in 2003 as part of a clinical trial programme and report here our experiences with this agent in 31 patients we have treated over the last 3 years. Here we share our standard procedures for patient selection, screening and treatment initiation, and report the efficacy and safety of efalizumab in our patients. Several case studies are presented to illustrate specific points of interest, such as the use of efalizumab in unstable psoriasis and management of arthropathy events. Finally, we suggest a number of approaches that may help to maximize the chances of long-term success in patients receiving efalizumab. In our hands, efalizumab has proven to be an effective therapy in the majority of patients (> 70%). The majority of these patients move to continuous efalizumab therapy (77%), the longest duration of which is currently 18 months. The main advantage of efalizumab over tumour necrosis factor-blockers is the lower risk of serious side-effects. By devising and disseminating effective strategies for the management of patients receiving efalizumab therapy, we hope this treatment will offer patients a truly continuous, long-term solution to their disease.