Approaches to discontinuing efalizumab: an open-label study of therapies for managing inflammatory recurrence

An open-label, multicentre, investigational study was performed in 41 patients with moderate-to-severe plaque psoriasis who had recently completed clinical studies with efalizumab and had developed signs of inflammatory recurrence following abrupt cessation of treatment. Patients were assigned by the attending physicians to receive one of five standardised alternative systemic psoriasis treatment regimens for 12 weeks. Efficacy of the different therapy options was assessed using the physician's global assessment (PGA) of change over time.More favourable PGA responses were observed in patients changing to cyclosporin (PGA of 'good', 'excellent' or 'cleared': 7/10 patients, 70.0%) or methotrexate (9/20, 45.0%), compared with those receiving systemic corticosteroids (2/8, 25.0%), retinoids (0/1, 0.0%) or combined corticosteroids plus methotrexate (0/2, 0.0%). While the majority (77.8%) of patients showed inflammatory morphology at baseline, following 12 weeks of the alternative therapies the overall prevalence of inflammatory disease was decreased to 19.2%.Inflammatory recurrence after discontinuation of efalizumab therapy is a manageable event, with a number of therapies and approaches available to physicians, including short courses of cyclosporin or methotrexate.Psoriasis is an inflammatory skin disorder that affects approximately 2–3% of the population [1] and has a profound impact on quality of life, equivalent to that of other major diseases [2]. Patients with the disease present with well-defined, thickened erythematous patches, typically covered with a silver scale, and the condition is characterised by epidermal hyperplasia, dermal angiogenesis, infiltration of activated T-cells and increased cytokine levels [3]. Chronic psoriasis is a condition requiring long-term medication. Systemic therapies are required by patients with moderate-to-severe disease; a variety of systemic therapies are available, but many of the current agents have serious side-effects that