Treatment of chronic plaque psoriasis by selective targeting of memory effector T lymphocytes - PubMed (original) (raw)
Clinical Trial
. 2001 Jul 26;345(4):248-55.
doi: 10.1056/NEJM200107263450403.
Affiliations
- PMID: 11474662
- DOI: 10.1056/NEJM200107263450403
Free article
Clinical Trial
Treatment of chronic plaque psoriasis by selective targeting of memory effector T lymphocytes
C N Ellis et al. N Engl J Med. 2001.
Free article
Abstract
Background: Psoriatic plaques are characterized by infiltration with CD4+ CD45RO+ and CD8+ CD45RO+ memory effector T lymphocytes. The recombinant protein alefacept binds to CD2 on memory effector T lymphocytes, inhibiting their activation.
Methods: In a multicenter, randomized, placebo-controlled, double-blind study, we evaluated alefacept as a treatment for psoriasis. Two hundred twenty-nine patients with chronic psoriasis received intravenous alefacept (0.025, 0.075, or 0.150 mg per kilogram of body weight) or placebo weekly for 12 weeks, with follow-up for 12 additional weeks. Before treatment, the median scores on the psoriasis area-and-severity index were between 14 and 20 in all groups (0 denotes no psoriasis and 72 the most severe disease possible).
Results: Alefacept was well tolerated and nonimmunogenic. The mean reduction in the score on the psoriasis area-and-severity index two weeks after treatment was greater in the alefacept groups (38, 53, and 53 percent in the groups receiving 0.025, 0.075, and 0.150 mg per kilogram, respectively) than in the placebo group (21 percent, P<0.001). Twelve weeks after treatment, 28 patients who had received alefacept alone were clear or almost clear of psoriasis. Three patients in the placebo group were clear or almost clear; all three had received additional systemic therapy for psoriasis. Alefacept reduced peripheral-blood memory effector T-lymphocyte (CD45RO+) counts, and the reduction in the number of memory-effector T lymphocytes was correlated with the improvement in psoriasis.
Conclusions: Treatment with alefacept for 12 weeks is associated with improvement in chronic plaque psoriasis; some patients have a sustained clinical response after the cessation of treatment. Alefacept selectively targets CD45RO+ memory effector T lymphocytes, suggesting that they have a role in the pathogenesis of psoriasis.
Comment in
- New treatments for psoriasis.
Granstein RD. Granstein RD. N Engl J Med. 2001 Jul 26;345(4):284-7. doi: 10.1056/NEJM200107263450410. N Engl J Med. 2001. PMID: 11474669 No abstract available. - Treatment of plaque psoriasis.
Millard TP, Birch KE, Young ER. Millard TP, et al. N Engl J Med. 2001 Dec 20;345(25):1853-4; author reply 1854-5. doi: 10.1056/NEJM200112203452516. N Engl J Med. 2001. PMID: 11752368 No abstract available. - Treatment of plaque psoriasis.
Haserick JR. Haserick JR. N Engl J Med. 2001 Dec 20;345(25):1854; author reply 1854-5. N Engl J Med. 2001. PMID: 11803919 No abstract available. - Treatment of plaque psoriasis.
Hanauer L. Hanauer L. N Engl J Med. 2001 Dec 20;345(25):1854; author reply 1854-5. N Engl J Med. 2001. PMID: 11803920 No abstract available. - Alefacept for psoriasis: promising drug, open questions.
Naldi L. Naldi L. Arch Dermatol. 2002 Sep;138(9):1238-40. doi: 10.1001/archderm.138.9.1238. Arch Dermatol. 2002. PMID: 12224990 No abstract available.
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