The Greek experience with efalizumab in psoriasis from a University Dermatologic Hospital

Summary Background  Efalizumab (anti‐CD11a antibody) targets T cell‐mediated steps important in the immunopathogenesis of psoriasis. As efalizumab is intended to be administered on a continuous long‐term basis in psoriasis, it is important to share experience concerning issues commonly occurring during its use in real daily practice. Objective  To evaluate the efficacy and safety of efalizumab treatment in Greek patients with moderate‐to‐severe plaque psoriasis, and to investigate whether there are specific characteristics that predict the clinical outcome of therapy. Patients  Seventy‐two patients with moderate‐to‐severe plaque psoriasis, who had failed to respond to, or had a contraindication to, or were intolerant to other systemic therapies, received efalizumab (1 mg kg −1 per week) for 12 weeks or more. Results  After 12 weeks of efalizumab treatment, 65% of patients achieved 50% or more improvement from baseline Psoriasis Area and Severity Index (PASI) and 39% achieved at least 75% reduction in PASI score. The mean percentage PASI improvement from baseline was 62%. The most common side effects were a flu‐like syndrome, a transient localized papular eruption, leucocytosis and lymphocytosis. There was no correlation between the occurrence of these side effects and the clinical response. Patients with a past history of unstable types of psoriasis were likely poor responders to efalizumab, and at an increased risk of developing generalized inflammatory flare. Conclusion  These results confirm previous reports suggesting that treatment with efalizumab is an efficacious and safe option for patients with moderate‐to‐severe plaque psoriasis. A detailed previous history of psoriasis is important in order to select possible candidates for efalizumab therapy.