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- W2028392989 abstract "Methotrexate is an effective systemic treatment for moderate to severe psoriasis, but its use is limited because of safety concerns. For example, short-term exposure is associated with bone marrow toxicity and long-term therapy with hepatotoxicity. Patients receiving methotrexate require routine blood and platelet counts, liver function tests, and blood urea nitrogen and creatinine levels. A liver biopsy is required at cumulative methotrexate doses of 1.0-1.5 g and every 1-1.5 g thereafter provided liver function tests and biopsy findings are normal. Methotrexate also has numerous drug interactions, which may result in additive or synergistic toxicity. The generalized immunosuppressive effects of methotrexate may increase the potential for infections and malignancies. In addition, it is an abortifacient and a teratogen. Alefacept is the first biologic agent to be approved in the US for the treatment of moderate to severe chronic plaque psoriasis. This agent has a remittive mechanism of action—it selectively reduces the T-cell population implicated in the pathogenesis of psoriasis. Alefacept has demonstrated placebo-like tolerability in clinical studies, with no evidence of an increased risk for infections or malignancies. In clinical practice, patients being treated with methotrexate need a safe and effective strategy for discontinuing methotrexate and initiating alefacept. An open-label study is underway to determine the consistency and durability of response achieved by tapering the dose of methotrexate while initiating alefacept therapy in adult patients with chronic plaque psoriasis. All participants must be receiving methotrexate, have achieved at least 50% improvement in psoriasis while on methotrexate, and be naı̈ve to alefacept therapy. At the initiation of the study, the patient’s weekly dose of methotrexate will be reduced by 2.5 mg per week. At subsequent visits, each patient will be instructed about the dose of methotrexate to be used until the following visit. Depending on the patient’s dose of methotrexate entering the study, the weekly dose will be tapered over approximately 8 weeks with the aim of discontinuing methotrexate. Alefacept will be administered as 15 mg IM or 7.5 mg IV once weekly for 12 weeks followed by 4 months of observation. Assessments will include skin and disease evaluations, adverse events, and laboratory tests as specified in the package inserts for alefacept and methotrexate." @default.
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- W2028392989 date "2004-03-01" @default.
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- W2028392989 title "Alefacept in combination with tapering doses of methotrexate in patients with psoriasis" @default.
- W2028392989 doi "https://doi.org/10.1016/j.jaad.2003.10.528" @default.
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