Efalizumab in routine use: a clinical experience

With the advent of biological therapies, continuous long-term control of psoriasis is now becoming a reality. We report our experience with biologics based on the treatment of more than 550 psoriatic patients with such compounds at our special outpatient care center of Bio-Immunotherapy at the Department of Dermatology of the Medical University of Vienna. Approximately 220 of these patients are currently receiving efalizumab. In our hands, efalizumab was generally found to be safe and well tolerated and, after 12 weeks of treatment, resulted in a PASI reduction of 50% or more in approximately two-thirds of patients treated. In most of these 'early' responders, the therapeutic efficacy of efalizumab can be maintained for a prolonged period of time, in certain patients up to 36 months. Flares occurring during long-term therapy were rare and, in most instances, triggered by infections. During such flares, we usually do not discontinue efalizumab therapy, but rather try to combat the infection by appropriate antibiotics and to control the activity of the cutaneous eruption by the addition of topical (corticosteroids) and, when needed, systemic (e.g. methotrexate 15-20 mg week(-1) for 8-10 weeks) medication. In such a situation, it is of utmost importance for the care-taking physician to closely communicate with the affected patients in a scientifically competent fashion and to have an open ear for their concerns. This helps and improves patient compliance and minimizes the need for treatment discontinuation.