Safety and efficacy of alefacept, efalizumab, etanercept and infliximab in treating moderate to severe plaque psoriasis: a meta-analysis of randomized controlled trials.

BACKGROUND: The relatively recent introduction of biological agents to treat psoriasis presents clinicians with the need to objectively compare and contrast these agents to allow more effective treatment of their patients. OBJECTIVES: To evaluate and compare the efficacy and safety of biological agents in the treatment of plaque psoriasis. METHODS: (i) DATA SOURCES: Four parallel systematic reviews conducted through July 2006, including peer-reviewed data and U.S. Food and Drug Administration (FDA) reports. (ii) STUDY SELECTION: Randomized, controlled, double-blind, monotherapy trials of alefacept (n = 3), efalizumab (n = 5), etanercept (n = 4) and infliximab (n = 4); 16 studies comprising 7931 patients met inclusion criteria. (iii) DATA EXTRACTION: Efficacy was measured by Psoriasis Area and Severity Index (PASI) 75 achievement after 10-14 weeks of treatment, using intention-to-treat analysis. Safety was evaluated by the incidence of one or more adverse event(s) (AEs) and serious adverse event(s) (SAEs) during 10-30 weeks of treatment. RESULTS: Pooled relative risk (RR) and number needed to treat (NNT) of PASI 75 achievement compared with placebo was computed using Mantel-Haenszel methods and the random effects model. All biological agents for psoriasis were efficacious (P < 0.001); however, there was a graded response for achievement of PASI 75: infliximab (RR = 17.40, NNT = 2), etanercept (RR = 11.73, NNT = 3), efalizumab (RR = 7.34, NNT = 4) and alefacept (RR = 3.70, NNT = 8). The risk of one or more AEs was evaluated by RR and number needed to harm (NNH). This was increased in the alefacept (RR = 1.09, P = 0.03, NNH = 15), efalizumab (RR = 1.15, P < 0.001, NNH = 9) and infliximab (RR = 1.18, P < 0.001, NNH = 9) groups compared with placebo. SAEs were increased in a sensitivity analysis of four efalizumab trials (n = 2443, RR = 1.92, P = 0.03, NNH = 60). CONCLUSIONS: The decreasing rank order for pooled efficacy was infliximab, etanercept, efalizumab and alefacept when compared with placebo. Pooling safety data revealed a previously unreported increased risk of AEs for alefacept, efalizumab and infliximab.

Single-photon emission computed tomography in human immunodeficiency virus encephalopathy: a preliminary report.

Depression or psychosis in a previously asymptomatic individual infected with the human immunodeficiency virus (HIV) may be psychogenic, related to brain involvement by the HIV or both. Although prognosis and treatment differ depending on etiology, computed tomography (CT) and magnetic resonance imaging (MRI) are usually unrevealing in early HIV encephalopathy and therefore cannot differentiate it from psychogenic conditions. Thirty of 32 patients (94%) with HIV encephalopathy had single-photon emission computed tomography (SPECT) findings that differed from the findings in 15 patients with non-HIV psychoses and 6 controls. SPECT showed multifocal cortical and subcortical areas of hypoperfusion. In 4 cases, cognitive improvement after 6-8 weeks of zidovudine (AZT) therapy was reflected in amelioration of SPECT findings. CT remained unchanged. SPECT may be a useful technique for the evaluation of HIV encephalopathy.

Single photon emission computed tomography (SPECT) with [123I]IMP in the differential diagnosis of psychiatric disorders.

Single photon emission computed tomography (SPECT) with [123I]N-isopropyl iodoamphetamine--[123I]IMP--was used to study regional cerebral blood flow (rCBF) in 94 psychiatric patients and six controls. Patients with dementias had distinct brain-image patterns, consistent with the expected neuropathology. Major depressives had decreased cortical and subcortical rCBF. Increased caudate rCBF was observed in schizophrenics and other psychoses with positive symptoms. SPECT is a practical method of functional brain imaging with potential in the differential diagnosis of neuropsychiatric disorders. Further studies are needed to assess the effect of other variables on brain-image patterns.

Epilepsy in prison: elevated prevalence and no relationship to violence.

The epidemiologic, clinical, and social characteristics of epilepsy were investigated in men entering the Illinois prison system and compared with a matched control group of prisoners without epilepsy. The prevalence of epilepsy was 2.4%, four times higher than the prevalence among men aged 20 to 39 in Rochester, MN. Head trauma was the probable cause of epilepsy among 45% of the prisoners with epilepsy, a much higher percentage than that reported in studies of other populations. In comparison with an age- and race-matched group of prisoners without epilepsy, the epilepsy group was not convicted of more serious or more violent crimes.

Increased prevalence of seizure disorders among prisoners.

In an effort to determine the prevalence of seizure disorders among persons confined to jails and prison, the prescription rates for anticonvulsant medications in ten Illinois correctional institutions were surveyed. The institutions housed 12,030 persons at the time of the survey. Analysis of the results of the survey suggests a point prevalence of seizure disorders of 1.9% among the Illinois prison and jail population. This estimated prevalence of seizure disorders is approximately three times higher than among middle-class nonprisoner populations on which previous epidemiologic studies of epilepsy have been based. Special programs and resources for the detection, treatment, and prevention of seizure disorders among prisoners appear necessary. Provisions to ensure continuity of care after release from incarceration are also needed.