Systemic Therapy for Psoriasis

Melvin Lee, MD; Robert E. Kalb, MD


Dermatology Nursing. 2008;20(2):105-111. 

In This Article

Efalizumab (Raptiva®)

Efalizumab is a humanized monoclonal antibody against CD11a and is thought to work by inhibiting T-cell activation and migration. Weekly subcutaneous injections of the medication are dosed based on the weight of individual patients (0.7 mg/kg once, then 1 mg/kg every week up to a maximum of 200 mg). Efalizumab maintains efficacy in heavier patients and thus may be more efficacious for that subset of patients compared to medications with fixed dosing (Clark & Lebwohl, 2008). Efalizumab is also distinct in having shown efficacy in hand and foot psoriasis including a placebo-controlled trial (Fretzin, Crowley, Jones, Young, & Sobell, 2006; Leonardi, Sofen & Krell, 2007).

Flu-like symptoms may accompany the first few injections of efalizumab, with improvement after several doses (Dubertret et al., 2006). Possible serious adverse events include infections, malignancy, thrombocytopenia, and autoimmune he molytic anemia.

Patients occasionally may have disease flares while on long-term therapy (Golda, Benham, & Koo, 2006; Hamilton, 2005). Topical steroids can be used for mild flares, while cyclosporine may be needed for the rare severe flare (Papp, Toth, & Rosoph, 2006).


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