Strategies for optimizing treatment with efalizumab in moderate to severe psoriasis

The evaluation of psoriasis therapy with biologics leads to a revision of the current view of the pathogenesis of this disorder

Psoriasis is a common chronic, recurring skin disease that is characterised by typical macroscopic and microscopic skin alterations. It is widely accepted that the immune system plays an important role in the pathogenesis of this disorder. Since the early 1990s, the dominant role of a subpopulation of T cells, so-called T1 cells, and their prominent cytokine IFN-gamma has been assumed in the pathogenesis of psoriasis. Surprisingly, the comparison of the therapeutic success of treatments with recombinant proteins directed against defined immunological structures shows that those that directly affect T cells (alefacept, efalizumab, Hu-max-CD4, OKTcdr4a) were clearly less effective than those targeting TNF-alpha (etanercept, adalimumab, infliximab). For this reason, the authors critically re-evaluated the view of psoriasis pathogenesis and postulate that in the majority of patients the T1 cells do not play a dominant role in the clinical, visible stage of this disease.

Efalizumab: integrating a new biologic agent into the long-term management of moderate to severe plaque psoriasis

Efalizumab, one of a new generation of biological agents, has been approved for use in moderate to severe psoriasis in over 35 countries including Canada. It may hold the promise of a new level of safe, long-term disease control for psoriasis patients, who have had few adequate options to date. Dermatologists and other caregivers may require some background regarding the mechanisms of action and the optimal use of this drug before integrating it into their standard repertoire of treatment. The present supplement discusses efalizumab's biological basis and reviews its clinical safety and efficacy. The salient differences amongst the various biologicals, with regard to safety, efficacy and convenience, are also considered. The supplement concludes with a practical guide to initiating and maintaining patients on efalizumab treatment.