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Amevive Combination Therapy Studied (Again)
from Bettye G.

Ed:  My son, 22 years old, is currently on cyclosporine but will have to come off soon so I have been desperately looking for anything new to help him.  I came across this and thought you might be interested since you are considering Amevive.  It is a paragraph from the following article:

http://www.medscape.com/viewarticle/453360

Combination therapy with alefacept and narrowband UVB is a treatment on the horizon which may offer more rapid psoriasis clearance. In a study of combination therapy with alefacept and UVB light, 30 patients were randomized to either alefacept alone, alefacept plus 6 weeks of narrowband UVB, or alefacept plus 12 weeks of narrowband UVB. One hundred percent of the patients receiving alefacept plus either course of UVB achieved PASI 75 (75% or greater PASI improvement). It is interesting to note that 80% of subjects receiving alefacept alone achieved PASI 75. It appears from this small study that the combination of alefacept and ultraviolet light is well tolerated. While the combination appears quite effective, alefacept alone in this study appeared more effective than it has in previously reported trials.

-Bettye G.

*****

Ed’s Response:  Thanks for the link and the quote, Bettye.  I always find studies like this interesting — probably because I’m never quite sure what to conclude from them.  If I understand the research results correctly, (1) everybody got better, meaning those that took only Amevive, those that took Amevive plus conventional UVB, and those that took Amevive plus narrowband UVB; (2) those who had light therapy with Amevive got slightly better than those who took Amevive alone over the 6 week period; and (3) those who took Amevive alone got a little bit better, statistically, in 6 weeks, than earlier studies would have predicted.

Another important (I guess) conclusion from this study is that the combination therapy involving Amevive and UVB (conventional OR narrowband) doesn’t seem to bring on any more adverse reactions than have been noted with any of these therapies singly.  Which means together they work slightly better than any of them alone, and together they don’t aggravate each other.

To me this means one more strategy in our armory to combat P.  We also need to bear in mind that Amevive by itself is expensive $10,000-$15,000 for a 12-week course.  Presumably, a concurrent course of light therapy requiring dermatology office visits, would add to this cost.

Here’s what I would do with this information IF I could tolerate UVB light therapy (which I can't).  I would start my course of Amevive assuming the best with no combination therapy.  In about six weeks I’d ask my derm to assess my progress.  If my derm and I agree that I’m not improving as much as I should be, then I would consider adding the UVB therapy (if my insurance pays for it!).

Though I am planning to start Amevive in early 2004, I doubt whether the UVB therapy addition will ever be an option for me.  All my earlier attempts at UVB/A light therapy regimens (including PUVA) have failed because my skin won’t tolerate enough exposure to the rays.  In short, I “sunburn” too easily.

I’d appreciate hearing from anyone who does try the Amevive/UVB combo therapy. -Ed

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