ABSTRACT
Topical agents for the treatment of psoriasis are indicated for patients whose affected area is less then 10% of their skin. However, for long-term use, their effectiveness can be limited. Topical sequential therapy involves the application of a class I corticosteroid and calcipotriene in three different phases: the clearance phase, the transition phase and the maintenance phase. It is an accepted and widely practiced technique that provides a balance between maximizing efficacy and minimizing side-effects thus offering patients rapid clearance of their psoriatic lesions and long-term maintenance of remission.
Subject(s)
Calcitriol/analogs & derivatives , Dermatologic Agents/therapeutic use , Psoriasis/drug therapy , Administration, Topical , Adrenal Cortex Hormones/therapeutic use , Calcitriol/therapeutic use , Drug Therapy, Combination , HumansABSTRACT
BACKGROUND: Alefacept, a fully human LFA-3/IgG(1) fusion protein, is a selective biological agent approved in the United States for the treatment of chronic plaque psoriasis. In phase 3 trials, clinical improvement and prolonged off-treatment remission of psoriasis correlated with reductions in circulating memory T cells. Reductions in pathogenic epidermal T cells in psoriatic lesions also have been noted following phototherapy with ultraviolet B (UVB) light. Because alefacept and UVB target T cells in different ways, combination therapy with these two agents may lead to greater efficacy. OBJECTIVES: To determine the safety, tolerability, and efficacy trends of combination therapy with alefacept plus UVB light in patients with chronic plaque psoriasis. METHODS: In an open-label, parallel-group study conducted at two sites, one in France and one in the United States, patients with chronic plaque psoriasis who were candidates for phototherapy received 12-weekly intramuscular injections of alefacept, 15 mg. In addition, patients were randomized to one of three treatment arms: no UVB treatment, 6-week UVB treatment, and 12-week UVB treatment. UVB treatment consisted of narrowband (NB) UVB at the site in France and broadband (BB) UVB at the site in the United States. The 12-week treatment period was followed by a 12-week follow-up period. Clinic visits occurred weekly during treatment and every 2-4 weeks during follow-up. RESULTS: A total of 60 patients (n = 30/site) were enrolled in the study. Alefacept was well tolerated when administered in combination with UVB treatment and as monotherapy. There was no evidence of increased phototoxicity or photosensitivity with the combination. At each study site, alefacept/UVB provided a higher overall response rate and led to a more rapid onset of response compared with alefacept monotherapy. Of patients who achieved > or = 50% reduction from baseline Psoriasis Area Severity Index (PASI 50) at 2 weeks after the last dose of alefacept, 75-100% in the combination therapy groups maintained this response throughout follow-up in the absence of further psoriasis therapy. CONCLUSIONS: In patients with chronic plaque psoriasis, combination therapy with alefacept plus short-term (6-12 weeks) UVB treatment is well tolerated with a trend toward greater and more rapid efficacy than alefacept alone.
Subject(s)
Psoriasis/diagnosis , Psoriasis/therapy , Recombinant Fusion Proteins/administration & dosage , Ultraviolet Therapy/methods , Adult , Aged , Alefacept , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , France , Humans , Injections, Intramuscular , Male , Middle Aged , Probability , Prospective Studies , Reference Values , Risk Assessment , Severity of Illness Index , Single-Blind Method , Treatment OutcomeABSTRACT
Narrow-band ultraviolet B (UVB) is a newer treatment modality for photoresponsive skin diseases. Since its introduction, dermatologists continue to use it for a myriad of dermatoses. Polycythemia vera is one cause of intractable pruritus that has recently been treated successfully with narrow-band UVB. We describe the case of a 77-year-old Caucasian male with a 4-year history of polycythemia vera complicated by intractable pruritus. Narrow-band UVB was successfully used to treat his pruritus. The patient noted an improvement in pruritus within the first four treatments and almost complete resolution after 18 treatments.
Subject(s)
Polycythemia Vera/complications , Pruritus/etiology , Pruritus/radiotherapy , Ultraviolet Therapy , Aged , Humans , MaleABSTRACT
Even before the recent development of biological agents, a long list of effective treatments has been available for patients with psoriasis. Topical therapies such as corticosteroids, vitamin D analogues, and retinoids are used for localised disease. Phototherapy including broadband ultraviolet B (UVB), narrowband UVB, PUVA, and climatotherapy are effective for more extensive disease. Systemic therapies such as methotrexate, retinoids, and ciclosporin are effective for patients with refractory or extensive cutaneous disease.
