Efalizumab for Psoriasis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Shengli ¹ , YAN Jun ² , LIU Yi ¹ , XU Xiulian ¹ ,  SUN Jiangfang ¹ , WU Taixiang ³

1. Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China 2. Institute of Dermatology prevention and treatment of Jinan, Jinan 250001, China 3. Evidence-based Medicine and Clinical Epidemiology Centre,West China hospital, Sichuan University,Chengdu 610041,China;

Corresponding author：

SUN Jiangfang, Email: shengli28@163.com

Keywords：

Efalizumab; Chronic plaque psoriasis; Randomized controlled trials; Systematic review; Meta-analysis

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Objective 　To assess the efficacy and safety of efalizumab in the treatment of psoriasis.
Methods 　Randomized controlled trials (RCT) on efalizumab in the treatment of psoriasis were identified from The Cochrane Library ( issue 1, 2006) , specialized trials registered in Cochrane Skin Group (2006), MEDLINE (1966 - 2006) and EMBASE (1974 - 2006). The quality of the trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by the Cochrane Collaboration was used for statistical analysis.
Results 　Three RCTs involving 1 651 patients were included, all of which were of high methodological quality. All the patients were diagnosed as chronic moderate to severe plaque psoriasis with the age of 18-75 years. Meta-analysis indicated that at week 12, significantly more patients in both 1mg/kg/w and 2 mg/kg/w efalizumab subcutaneous groups achieved PASI50, PASI75, PASI90 improvement compared to the placebo group (P lt;0.0001), while there was no significant difference in PASI50, PASI75 and PASI90 responses between 1mg and 2mg efalizumab groups (P gt;0.05). No serious adverse effects were identified. Extended treatment for another 12w may contribute to further efficacy without increasing toxicty.
Conclusions 　Efalizumab 12w therapy is safe and effective for treating adult patients with moderate to severe plaque psoriasis. More RCTs are required to assess the efficacy of the extended treatment.

Citation： CHEN Shengli,YAN Jun,LIU Yi,XU Xiulian,SUN Jiangfang,WU Taixiang. Efalizumab for Psoriasis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(4): 267-272. doi: Copy

1.	Fredriksson T, Pettersson U. Severe psoriasis–oral therapy with a new retinoid. Dermatologica. 1978; 157:238-244.
2.	Lebwohl M, Tyring SK, Hamilton TK, et al. A novel targeted T-cell modulator, efalizumab, for plaque psoriasis. N Engl J Med, 2003;349(21):2 004-2 013.
3.	Leonardi CL, Papp KA, Gordon KB, et al. Extended efalizumab therapy improves chronic plaque psoriasis: results from a randomized phase III trial. J Am Acad Dermatol, 2005;52(3 Pt 1):425-433.
4.	Menter A, Gordon K, Carey W, et al. Efficacy and safety observed during 24 weeks of efalizumab therapy in patients with moderate to severe plaque psoriasis. Arch Dermatol, 2005;141(1):31-38.
5.	Gordon KB, Papp KA, Hamilton TK, et al. efalizumab for patients with moderate to severe plaque psoriasis: a randomized controlled trial. JAMA, 2003;290(23):3 073-3 080.
6.	Ricardo RR, Rhoa M, Orenberg EK, et al. Clinical benefits in patients with psoriasis after efalizumab therapy: clinical trials versus practice. Cutis, 2004;74(3):193-200.
7.	Gottlieb AB, Gordon KB, Lebwohl MG, et al. Extended efalizumab therapy sustains efficacy without increasing toxicity in patients with moderate to severe chronic plaque psoriasis. J Drugs Dermatol, 2004;3(6):614-624.
8.	[No authors listed] efalizumab (Raptiva) for treatment of psoriasis. Med Lett Drugs Ther, 2003;45(1 171):97-98.
9.	Papp K, Bissonnette R, Krueger JG, et al. The treatment of moderate to severe psoriasis with a new anti-CD11a monoclonal antibody. J Am Acad Dermatol, 2001;45:665-674.

1. Fredriksson T, Pettersson U. Severe psoriasis–oral therapy with a new retinoid. Dermatologica. 1978; 157:238-244.
2. Lebwohl M, Tyring SK, Hamilton TK, et al. A novel targeted T-cell modulator, efalizumab, for plaque psoriasis. N Engl J Med, 2003;349(21):2 004-2 013.
3. Leonardi CL, Papp KA, Gordon KB, et al. Extended efalizumab therapy improves chronic plaque psoriasis: results from a randomized phase III trial. J Am Acad Dermatol, 2005;52(3 Pt 1):425-433.
4. Menter A, Gordon K, Carey W, et al. Efficacy and safety observed during 24 weeks of efalizumab therapy in patients with moderate to severe plaque psoriasis. Arch Dermatol, 2005;141(1):31-38.
5. Gordon KB, Papp KA, Hamilton TK, et al. efalizumab for patients with moderate to severe plaque psoriasis: a randomized controlled trial. JAMA, 2003;290(23):3 073-3 080.
6. Ricardo RR, Rhoa M, Orenberg EK, et al. Clinical benefits in patients with psoriasis after efalizumab therapy: clinical trials versus practice. Cutis, 2004;74(3):193-200.
7. Gottlieb AB, Gordon KB, Lebwohl MG, et al. Extended efalizumab therapy sustains efficacy without increasing toxicity in patients with moderate to severe chronic plaque psoriasis. J Drugs Dermatol, 2004;3(6):614-624.
8. [No authors listed] efalizumab (Raptiva) for treatment of psoriasis. Med Lett Drugs Ther, 2003;45(1 171):97-98.
9. Papp K, Bissonnette R, Krueger JG, et al. The treatment of moderate to severe psoriasis with a new anti-CD11a monoclonal antibody. J Am Acad Dermatol, 2001;45:665-674.

Chinese Journal of Evidence-Based Medicine

Efalizumab for Psoriasis: A Systematic Review

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