[Which patient is a candidate for treatment with efalizumab and why?]

With the coming of the biological therapies, long-term maintained control of psoriasis is becoming a reality and means a significant improvement in the quality of life in some patients with persistent clearing of the disease. This result was difficult to obtain previously. Efalizumab, a recombinant IgG1 anti-CD11a antibody approved for the treatment of psoriasis in moderate-to-severe chronic plaques, has an excellent safety profile and its therapeutic results in the clinical practice have surpassed the expectations based on the clinical trials. At 12 weeks of treatment (when its efficacy should be evaluated), a PASI 75 response can be expected in 35 to 40% of the patients and a PASI 50 response in two thirds of them. This degree of improvement may be maintained and may even increase in 80% of the patients, making it possible to achieve an almost complete clearing in more than 40% of the patients who continue the treatment over several years. Localized, transitory exacerbations may appear, especially in the beginning of the treatment, but these can generally be managed in combination with another treatment. There may also be generalized inflammatory outbreaks, especially in patients with scarce or null response, who require treatment with a rapid effect systemic drug at the onset. This is because they may be a prelude to the development of rebounds, that may acquire an erythrodermic or pustular morphology or be accompanied by arthritis, and which tend to appear after the sudden withdrawal of the drug. An adequate selection of the patients may maximize the possibilities of success. Patients without arthritis and with stable, extensive and non-inflammatory forms of the disease tend to be the best candidates. Special attention should be given to the administration of systemic agents in transition regimes when efalizumab is introduced or withdrawn. The clinical criteria is fundamental to optimize the therapeutic results with efalizumab, that may be an attractive challenge but may also be an especially satisfactory therapeutic option when long-term control is the disease is proposed.