Study of the Drug Efalizumab (Raptiva), for Adult Patients With Moderate to Severe Plaque Psoriasis

Phase 3

Completed

Brief Summary: Our laboratory is studying a skin disease known as psoriasis. The purpose of this protocol is to study the action and the effects of Efalizumab, on psoriasis. This medication has been studied extensively and has been found to be effective and safe in the treatment of psoriasis. The eligible patient will have 10% of his/her body surface area involved with psoriasis vulgaris.

Detailed Description: The eligible patient will receive the drug Efalizumab, weekly for 12 weeks, by injection. The patient will be seen weekly for 12 weeks and every other week for the 12 weeks of follow up. At those visits, the patient can expect that a physical and skin exam will be done. At specific weeks, blood work will be drawn, clinical photography taken and a skin biopsy done. Two types of skin biopsies will be done after local anesthesia has been administered. One is a punch biopsy where a small piece of skin will be taken, the approximate size of a pencil eraser. The second type of skin biopsy is shave biopsy, where a postage sized piece of skin will be taken.

Recruitment & Eligibility

Inclusion Criteria

Signed informed consent

Plaque psoriasis covering >10% of total BSA
Diagnosis of plaque psoriasis for at least 6 months
PASI score >=12 (see Appendix A) or Linear PASI score of >= 8.0 at screening (see Appendix B)
In the opinion of the investigator, candidate for systemic therapy for psoriasis:
- Who has not been previously treated (naive to systemic treatment) OR
- Who has had prior treatment with systemic therapy for psoriasis (e.g., PUVA, cyclosporine, corticosteroids, methotrexate, oral retinoids, mycophenolate mofetil (MMF), thioguanine, hydroxyurea, sirolimus, azathioprine, 6-MP, etanercept)
Body weight of <140 kg
18 to 75 years old. As the risk of Efalizumab in childhood is unknown, those < 18years will be excluded from the study
For women of childbearing potential or in men whose partners may become pregnant, willingness to use an acceptable method of contraception to prevent pregnancy for the duration of the study (while receiving study medication and 3 months following). Acceptable methods of contraception include use of a condom; abstinence; use by sexual partner of oral implantable or injectable contraceptives, IUD, female condom, diaphragm with spermicide, cervical cap; or a sterile sexual partner
Willingness to hold sun exposure reasonably constant and to avoid use of tanning booths or other UV light sources during the study

Exclusion Criteria

Subjects who meet any of the following exclusion criteria are ineligible for study entry:

Guttate, erythrodermic, or pustular psoriasis as sole or predominant form of psoriasis
History of severe allergic or anaphylactic reactions to humanized monoclonal antibodies or fusion proteins that contain an Ig Fc region
Clinically significant psoriasis flare during screening or on the first treatment day
Treatment with efalizumab (anti-CD11a) within the last 12 months before enrollment
Pregnancy or lactation. As the risk of Efalizumab in pregnancy is unknown, pregnant women will be excluded from the study
History of or ongoing uncontrolled bacterial, viral, fungal, or atypical mycobacterial infection
History of active tuberculosis (TB) or currently undergoing treatment for TB. PPD testing or chest X-ray is required for high-risk subjects (see Appendix D).

Subjects with a positive PPD (not due to BCG vaccination) or chest X-ray will be excluded

History of opportunistic infections (e.g., systemic fungal infections, parasites)
Seropositivity for human immunodeficiency virus (HIV)
Seropositivity for hepatitis B or C virus
Hepatic enzymes >3 times the upper limits of normal (ULN)
Diagnosis of hepatic cirrhosis, regardless of cause or severity
WBC count <4000μL or >14,000/μL
Serum creatinine >2 times the ULN
Hospital admission for cardiac disease, stroke, or pulmonary disease within the last year
Presence of malignancy within the past 5 years, including lymphoproliferative disorders. Subjects with a history of fully resolved basal cell or squamous cell skin cancer may be enrolled
History of substance abuse within the last 5 years
Any medical condition that, in the judgment of the investigator, would jeopardize the subject's safety following exposure to study drug Note: Certain medications and vaccines may not be used for specified periods of time prior to enrollment or at any time during the treatment period.

Exclusion Criteria

Not provided

Arm && Interventions

Group	Intervention	Description
psoriasis	Efalizumab	moderate to severe plaque psoriasis

Primary Outcome Measures

Name	Time	Method
Number of Participants With Clinical Improvement of Target Lesions	week 12	a single composite score based on quantitative measurement of epidermal acanthosis, qualitative expression of Keratin16 (histochemistry assessment) and quantitative measurement of K16 mRNA.

Secondary Outcome Measures

Name	Time	Method
Assessment of Overall Clinical Response as Measured by Psoriasis Area and Severity Index (PASI)	Day 0, day 14, day 42, day 84, Days 112, 140, and 168. PASI has been measured at those timepoints but outcome is related to Baseline and Day 84.	Psoriasis Area and Severity Index (PASI) combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease). Clinical response defined as PASI improvement over 75% at week 12.