An open-label study evaluating the efficacy and tolerability of alefacept for the treatment of scalp psoriasis

Background: Almost 50% of patients with psoriasis also have scalp psoriasis. Although alefacept is safe and effective for the treatment of generalized plaque psoriasis, its efficacy specifically for treating scalp psoriasis has not been formally evaluated. Objective. We sought to evaluate the efficacy and tolerability of alefacept in treating scalp psoriasis. Methods: Patients (n = 30) with psoriatic plaques covering 30% or more of scalp surface received 15 mg of intramuscular alefacept once weekly for 16 weeks (course 1), followed by 12 weeks of rest. Patients were evaluated for the condition of their scalp psoriasis using the scalp Physician's Global Assessment, a modified Psoriasis Area and Severity index for the scalp, and scalp Patient's Global Assessment 6 weeks after Course 1. Patients who had scalp Physician's Global Assessment scores greater than or equal to I at any time between this evaluation and 5 months after the rest period received an additional 12-week course of once-weekly intramuscular alefacept (15 mg) (course 2). Treatment success was defined as attaining scalp Physician's Global Assessment of clear (0) or almost clear (1) at 6 weeks after either treatment course. Results: Six weeks after course 1, 5 (16.7%) patients achieved clear or almost clear status of their scalp psoriasis. All 3 patients whose scalp psoriasis cleared remained clear until the end of the study. Six weeks after course 2, cumulatively, 8 (26.7%) patients achieved treatment success. Not all patients received both Courses. There were no treatment-related serious adverse events. Limitations: This was a single-arm, open-label, noncomparative trial. Conclusion: Alefacept is effective in a subset of patients with scalp psoriasis and is well tolerated.