CLINICAL CASES   

Esperienze Dermatologiche 2010 September;12(3):167-72

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English, Italian

Off-label use of efalizumab as alternative treatment for severe recalcitrant childhood psoriasis

Brunasso A. ¹, Lo Scocco G. ², Gulia A. ³, Curcic P. ⁴, Massone C. ⁴

¹ Clinica Dermatologica, Università di Medicina di Graz, Graz, Austria 2 Dipartimento di Dermatologia, Ospedale di Prato, Prato, Italia 3 Clinica Dermatologica, Università de L’Aquila, L’Aquila, Italia 4 Clinica Dermatologica, Università di Medicina di Graz, Graz, Austria

We report the case of a 13-year-old white female suffering from a severe plaque psoriasis since the age of 2 months. Topical and systemic medications were insufficient to control the disease. After two unsuccessful courses of infliximab, the severity of the disease (PASI 42.2) led us to initiate an off-label cycle of efalizumab 1 mg/kg a week. At week-12, 70% of PASI improvement was seen and the excellent clinical response was sustained until week-26 when efalizumab was suspended because of the EMEA recommendation. No infectious, hematological, or neurological events were seen and ANA titre remained negative. Cyclosporine was reintroduced at 5 mg/kg/day in order to avoid efalizumab associated rebound phenomenon, but after three weeks from withdrawal the patient was admitted to the hospital because of a severe psoriasis worsening (125% worsening from baseline PASI) associated to fever, malaise and lower limb edema. Even after efalizumab withdrawal from the market, we think that anyhow this report represents an example of the possible utility of specific blocking molecules as anti-CD11a in psoriasis also in pediatric patients. This report together with other observations, should motivate and sustain research in finding new anti-CD11a molecules that present a better efficacy and safety profile than efalizumab.