Efalizumab for Treatment of Patients With Moderate to Severe Psoriasis
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Multicentre, open label, phase III study. Subjects with moderate to severe psoriasis were given efalizumab subcutaneously once per week for the 12-week treatment period. Assessments involved physical examination, disease activity assessments, clinical laboratory tests (haematology, blood chemistry and standard urinalysis), evaluation of the Psoriasis Area and Severity Index (PASI), the Physician's Global Assessment (PGA), the Patient's Global Psoriasis Assessment (PGPA), the SF-36 Health Survey and psoriatic body surface area (BSA). The 12-week treatment period was followed by a 12-week follow-up (FU) period, during which other antipsoriatic medications were allowed. The same assessments were also performed in the 12-week FU period.
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Layout table for eligibility information
Ages Eligible for Study:
18 Years to 75 Years (Adult, Older Adult)
Sexes Eligible for Study:
Signed informed consent
Plaque psoriasis covering ³10% of total BSA
Diagnosis of plaque psoriasis for at least 6 months
A minimum PASI score of 12.0 at screening
In the opinion of the investigator, candidate for systemic therapy for psoriasis
Body weight of £120 kg
18 to 75 years old
For women of childbearing potential and for men whose partner can become pregnant, use of an acceptable method of contraception to prevent pregnancy and agreement to continue to practice an acceptable method of contraception for the duration of their participation in the study (including the FU period).
Willingness to hold sun exposure reasonably constant and to avoid use of tanning booths or other UV light sources during the study
Willingness to enter Study
Guttate, erythrodermic, or pustular psoriasis as sole or predominant form of psoriasis
History of severe allergic or anaphylactic reactions to humanised monoclonal antibodies or fusion proteins that contain an Ig Fc region
Clinically significant psoriasis flare during screening or at the time of enrollment that would necessitate immediate relief for that patient
History of or ongoing uncontrolled bacterial, viral, fungal, or atypical mycobacterial infection
History of opportunistic infections (e.g., systemic fungal infections, parasites)
Seropositivity for human immunodeficiency virus (HIV)
Patients will undergo mandatory testing at screening. Patients who are positive for HIV will be excluded.
Pregnancy or lactation
WBC count <4000/mL or >14,000/mL
Patients with an history of clinically significant thrombocytopenia, bleeding disorder or a platelet count <100,000/mL
Seropositivity for hepatitis B or C virus
Patients will undergo testing during screening. Patients who are positive for hepatitis B antigen or hepatitis C antibody will be excluded.
Hepatic enzymes ³3 times the upper limit of normal
History of active tuberculosis (TB) or currently undergoing treatment for TB
Chest X-ray within 3 months of Day 0 is required for all patients. Patients with a positive chest X-ray consistent with TB infection will be excluded.
Presence of malignancy within the past 5 years, including lymphoproliferative disorders
Patients with a history of fully resolved basal cell or squamous cell skin cancer may be enrolled even if it is less than 5 years.
Previous treatment with efalizumab (anti-CD11a)
Diagnosis of hepatic cirrhosis, regardless of cause or severity
Serum creatinine ³2 times the upper limit of normal
Hospital admission for cardiac disease, stroke, or pulmonary disease within the last year
History of substance abuse (e.g. narcotics, alcohol) within the last 5 years
Any medical condition that, in the judgment of the investigator, would jeopardize the patient's safety following exposure to study drug
Note: Restrictions and/or directions apply to the following treatments during specified time periods prior to initial study drug administration and during the study:
Systemic therapy for psoriasis within 28 days prior to Study Day 0
Systemic immunosuppressive drugs for other indications within 28 days prior to Study Day 0
Topical therapies for psoriasis within 14 days prior to Study Day 0
Live or killed virus or bacteria vaccines within 14 days prior to Study Day 0
Other vaccines or allergy desensitization within 14 days prior to study Day 0
Other experimental drugs or treatments within 28 days or five half lives, whichever is longer, prior to Day 0
Use of b Blockers, ACE inhibitors, interferons, quinidine, antimalarial drugs, or lithium (if clinically indicated, such medications are allowed but the dosage should be held constant from Day -28 throughout the study)