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Combo therapy speeds response in psoriasis.

San Francisco -- Combining alefacept with acitretin and narrow-band UVB in patients with plaque-type psoriasis is well tolerated and can induce early responses, three case reports indicate.

The triple therapy potentially can speed withdrawal of methotrexate or UVB therapy, Dr. Angela Moore reported in a poster presentation at the annual meeting of the American Academy of Dermatology.

The study was funded by Biogen Idec Inc., which makes alefacept.

Alefacept, a biologic T cell inhibitor, usually has an onset of action of 14-16 weeks when it is used as a single agent. Monotherapy with low-dose acitretin has an onset of action of about 3 months. The combination of low-dose acitretin with narrow-band UVB has previously been shown to speed responses, wrote Dr. Moore, a dermatologist in Arlington, Tex.

She and her associates evaluated the triple therapy in three patients with moderate to severe plaque-type psoriasis that was refractory to numerous treatments.

One patient, with a 20% body surface area (BSA) involvement, initially was treated with acitretin and narrow-band UVB. When he didn't show any improvement during 6 weeks of therapy, alefacept was added. After 7 weeks of the triple therapy, BSA involvement had declined to 3%.

A second patient, who had more than 80% BSA involvement, began to respond after 9 weeks of triple therapy. By week 11, BSA involvement was down to just 3%.

The third patient had 70% BSA involvement at the start of triple therapy. He showed significant improvement after 6 weeks, and his BSA involvement was only 4% at week 11.

While taking alefacept, CD4+ T cell counts decreased in all three patients. However, none of them developed clinical signs of infection or other side effects, Dr. Moore wrote.

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Title Annotation:Skin Disorders; alefacept with acitretin
Author:Boschert, Sherry
Publication:Family Practice News
Article Type:Brief article
Geographic Code:1USA
Date:Apr 15, 2006
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