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• W2028519277 abstract "The systemic agent cyclosporine has inhibitory effects on T-cell activation, which likely account for its efficacy in the treatment of moderate to severe psoriasis. However, the use of cyclosporine is limited because of dose-related toxicities (eg, hypertension, nephrotoxicity), which necessitate routine monitoring of its safety. Cyclosporine also causes generalized immunosuppression, which may increase the risk for infections and malignancies. For these reasons, continuous treatment with cyclosporine is not recommended for >1 year. Complete relapse of psoriasis generally occurs within 1 month after stopping cyclosporine therapy. 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. In clinical studies, the safety profile of alefacept has been comparable to placebo and there has been no evidence of an increased risk for infections or malignancies. In clinical practice, patients receiving cyclosporine need a safe and effective strategy for stopping cyclosporine and starting alefacept. An open-label study is underway in adult patients with chronic plaque psoriasis who are well controlled on cyclosporine and who need or desire to transition to alefacept therapy. In phase 1 (weeks 1–12), alefacept 7.5 mg will be administered by IV bolus once weekly, while cyclosporine will be tapered from 4 mg/kg/day (weeks 1–4), to 3 mg/kg/day (weeks 5–8), and then to 2.5 mg/kg/day (weeks 9–12). Topical therapy will also be permitted. After the 12th alefacept dose, both alefacept and cyclosporine will be discontinued. In phase 2 (weeks 12–24), patients will be off both alefacept and cyclosporine, but may receive topical therapy and UVB phototherapy as per physician’s standard of care. In phase 3 (weeks 24–48), patients can receive a repeat course of IV alefacept 7.5 mg once weekly for 12 weeks if clinically indicated followed by 12 weeks of observation. Topical therapy will be permitted throughout phase 3, and UVB phototherapy will be allowed during the observation period. Cyclosporine will not be administered in phase 3. Assessments will include a Physician Global Assessment, the Dermatology Life Quality Index, adverse events, physical examinations, and laboratory tests as specified in the package inserts for alefacept and cyclosporine." @default.
• W2028519277 created "2016-06-24" @default.
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• W2028519277 date "2004-03-01" @default.
• W2028519277 modified "2023-09-27" @default.
• W2028519277 title "Alefacept in combination with tapering doses of cyclosporine in patients with psoriasis" @default.
• W2028519277 doi "https://doi.org/10.1016/j.jaad.2003.10.011" @default.
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