Patients with severe atopic dermatitis are often treated with systemic corticosteroids, cyclosporine, and other drugs that can have serious adverse effects. Moreover, immunosuppressants should be taken only for a limited time because of the risk of organ toxicities.
To have the option of a targeted systemic drug that could work safely over the long term would be a welcome change. A small study at Oregon Health and Science University suggests that efalizumab (Raptiva, Genentech), already approved for the treatment of chronic moderate-to-severe plaque psoriasis, might be a solution. In the study, six of 10 patients improved by at least 50% over the 12-week treatment period.
The patients received the dose indicated for psoriasis: an initial conditioning subcutaneous dose of efalizumab of 0.7 mg/kg, followed by 1 mg/kg weekly for another 11 weeks.
The patients were monitored for 20 weeks. The mean Eczema Area and Severity Index (EASI) score at baseline was 37; at week 12, the mean score was 17.6. All 10 patients showed some improvement; six achieved an EASI score of 50, and two achieved EASI 75 at week 12.
The drug was well tolerated. Secondary bacterial infection was the most common adverse event during the study. With 120 doses administered, only one serious adverse event occurred. One patient had thrombocytopenia, which has also been reported in 0.3% of patients with psoriasis treated with efalizumab.
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The 53% improvement rate seen in this study was better than improvements reported with interferon-gamma (e.g., Actimmune, InterMune) and azathio-prine (Azasan, Imuran, Salix), and was comparable to results with cyclosporine and mycophenolate mofetil (CellCept, Roche). Moreover, the clinical response was almost three times the expected placebo response seen in a study of injectable interferon-gamma.
At the end of the study, five patients requested further efalizumab therapy.