Efalizumab: a review of its use in the management of chronic moderate-to-severe plaque psoriasis.

Efalizumab (Raptiva) is a recombinant, humanized, monoclonal antibody that targets CD11a, the alpha-subunit of the heterodimeric lymphocyte surface protein lymphocyte function-associated antigen-1 (LFA-1). It is approved for the treatment of adult patients (aged > or = 18 years) with chronic moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy (in the US), or who have failed to respond to, have a contraindication to, or are intolerant of, other systemic therapies, including cyclosporine (ciclosporin), methotrexate, and psoralen plus UVA photochemotherapy (in the EU). Weekly subcutaneous injections of efalizumab are effective and generally well tolerated in the treatment of adults with chronic moderate-to-severe plaque psoriasis, including high-need individuals (i.e. those for whom at least two currently available systemic therapies are unsuitable due to lack of efficacy, intolerance, or contraindication), and patients with difficult-to-treat forms of the disease affecting the scalp, hands/feet, or nails. Clinical improvements are maintained, with no evidence of cumulative or end-organ toxicity, during continuous administration of efalizumab for up to 3 years; 4-, 5-, and 7-year safety data are being collected. The therapeutic profile of efalizumab cannot be directly compared with that of other antipsoriasis agents because of a lack of head-to-head comparative studies. Nonetheless, a considerable body of data indicates that efalizumab is an appropriate alternative to other biologic or nonbiologic therapies for the treatment of chronic moderate-to-severe plaque psoriasis that, additionally, offers the potential convenience of self-injection at home.