Alefacept Brand Name– Amevive
What is Alefacept
NOTE: This drug is discontinued in the U.S.
- Alefacept was a recombinant human leukocyte-function-associated antigen type 3 (LFA-3)/IgG1 fusion protein.
- Alefacept, a 91.4 kDa glycosylated protein, is produced by recombinant DNA technology in a Chinese hamster ovary (CHO) cell expression system. It possesses immunomodulatory and immunosuppressive effects.
- Alefacept is composed of the first extracellular domain of the leukocyte-function-associated antigen type 3 (LFA-3), which is the ligand for CD2, fused to portions of the human IgG1 heavy chain [IgG1 hinge, C(H)2, and C(H)3 domains]. The LFA3-CD2 signal pathway is important in the activation of T-cells that are believed to be the key mediators of psoriasis.
- Use of alefacept resulted in clinical improvement of psoriasis, including psoriasis area severity index (PASI); however, the drug has to be given in a cyclic manner (12-week treatment course, followed by 12 weeks of no treatment). Thus, use was limited to 2 cycles of treatment per year and full clearance of symptoms and signs of psoriasis occurred in only a small minority of patients with use.
- The drug showed promise for treatment of psoriatic arthritis (PsA). However, guidelines for psoriatic arthritis have not recommend use of alefacept.
- Alefacept was approved by the FDA in 2003. Following approval, the drug carried many of the risks associated with biologic therapies, including a risk for serious infections. The drug is known to deplete CD4-T lymphocytes in some patients. Postmarketing, liver injury cases were reported with use.
- In December 2011, marketing and promotion of alefacept was voluntarily ceased by the manufacturer.
Indications & Dosage
- Psoriasis
- Psoriatic arthritis
For the treatment of moderate to severe chronic plaque psoriasis in patients who are candidates for systemic therapy or phototherapy
Side Effects
- angioedema
- antibody formation
- chills
- cholecystitis
- cirrhosis
- cough
- dizziness
- elevated hepatic enzymes
- hepatic failure
- hepatitis
- hepatotoxicity
- immunosuppression
- infection
- injection site reaction
- lymphopenia
- myocardial infarction
- nausea
- new primary malignancy
- pharyngitis
- pruritus
- rash
- urticaria
- vomiting
Mechanism of action:
Alefacept works by binding to the CD2 receptor on T lymphocytes, a type of immune cell involved in the pathogenesis of psoriasis. This binding inhibits the activation and proliferation of T cells, reducing the immune response that contributes to the development of psoriatic plaques.
Effects on psoriasis:
Alefacept helps to improve psoriasis symptoms by reducing the thickness and scaling of the plaques, decreasing the redness and inflammation, and minimizing itching. It also helps to slow down the rapid turnover of skin cells that occurs in psoriasis.
Administration
Alefacept is typically administered through intramuscular injection. The treatment regimen usually involves a series of weekly injections for 12 weeks, followed by a break in therapy, and then additional treatment cycles as needed.
Usage considerations
Alefacept is generally reserved for patients with moderate to severe plaque psoriasis who have not responded well to other treatments or who have contraindications or intolerance to other systemic therapies. It is not recommended for use in individuals with compromised immune function or active infections.
Monitoring Parameters
- CD4+ T cell count
Contraindications
- acquired immunodeficiency syndrome (AIDS)
- breast-feeding
- chemotherapy
- children
- diabetes mellitus
- ethanol ingestion
- fungal infection
- geriatric
- hamster protein hypersensitivity
- hepatic disease
- hepatotoxicity
- herpes infection
- human immunodeficiency virus (HIV) infection
- immunosuppression
- infants
- infection
- lymphoma
- neoplastic disease
- new primary malignancy
- pregnancy
- radiation therapy
- sepsis
- vaccination
- varicella
- viral infection
Interactions
- Antithymocyte Globulin
- Azathioprine
- Bacillus Calmette-Guerin Vaccine, BCG
- Basiliximab
- Cyclophosphamide
- Cyclosporine
- Dexamethasone
- Efalizumab
- Influenza Virus Vaccine
- Intranasal Influenza Vaccine
- Live Vaccines
- Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
- Measles/Mumps/Rubella Vaccines, MMR
- Methotrexate
- Methoxsalen
- Methylprednisolone
- Muromonab-CD3
- Prednisone
- Rotavirus Vaccine
- Rubella Virus Vaccine Live
- Smallpox and Monkeypox Vaccine, Live, Nonreplicating
- Smallpox Vaccine, Vaccinia Vaccine
- Typhoid Vaccine
- Varicella-Zoster Virus Vaccine, Live
- Yellow Fever Vaccine, Live
It’s important to note that the information provided here is a general overview, and specific details regarding the use, dosage, and safety of alefacept may vary.
It is essential to consult with a healthcare professional or dermatologist for personalized guidance and recommendations based on individual circumstances and medical history.
