Alefacept

Indications

Alefacept is used for: Psoriasis

Adult Dose

Psoriasis Indicated for moderate-to-severe chronic plaque psoriasis 15 mg IM qWeek x 12 weeks Regimen of 12 weekly injections recommended Re-treatment with additional 12 week course may be initiated, based on normal CD4+ T lymphocyte counts and a minimum 12 week interval

Child Dose

Renal Dose

Administration

IV/IM Preparation IV: reconsitute 7.5 mg vial with 0.6 mL of the supplied diluent; 0.5 mL will contain 7.5 mg of drug IM: reconstitute 15 mg vial with 0.6 mL of supplied diluent; 0.5 mL will contains 15 mg of drug Withdraw 0.6 mL of supplied diluent using supplied syringe & needle Keep needle pointed at sidewall of vial & slowly inject diluent Gently swirl contents during dissolution; do not shake Reconstituted solution should be clear & colorless to slightly yellow; inspect solution for particulate matter Do not use if discolored, cloudy, or if undissolved material remains Do not reconstitute drug with other diluents Do not filter reconstituted solution during preparation or administration Use immediately or within 4 hr if stored in the vial at 2-8°C (36-46°F) IV/IM Administration Do not add other medications to solutions containing drug IM Withdraw & inject the full 0.5 mL of solution Rotate injection sites Give new injections at least 1 inch from an old site & never into areas where skin is tender, bruised, red, or hard IV Prepare 2 syringes with 3 mL NS for pre- & post-administration flush Prime the winged infusion set with 3 mL NS & insert into vein Attach drug-filled syringe to infusion set & administer over no more than 5 sec Flush infusion set with 3 mL NS

Contra Indications

Hypersensitivity CD4+ T lymphocyte count below normal HIV pts Pts at high risk for malignancy Lactation

Precautions

Monitor CD4+ T lymph counts weekly; withhold dosing if CD4 <250/mcL; discontinue if CD4 <250/mcL for one month Pts who become pregnant should enroll in the Biogen Pregnancy Registry (1-866-263-8483) May increase risk of malignancies Risk of serious infection, anaphylaxis 15 mg lyophilized powder for IM administration ; 7.5 mg lyophilized powder for IV administration

Pregnancy-Lactation

Pregnancy Category: B Lactation: excretion in milk unknown/not recommended

Interactions

Adverse Effects

Side effects of Alefacept : >10% Injection site reactions (16%) Lymphopenia (10-50%) 1-10% Malignancies (1.3%) Chills (6%) Pharyngitis (>2%) Dizziness (>2%) Nausea (>2%) Pruritis (>2%) Myalgia (>2%) Cough (>2%) ALT/AST elevation (1.7%) <1% Serious infections Hypersensitivity reactions CAD MI

Mechanism of Action

Recombinant dimeric fusion protein: extracellular CD2-binding portion of human leukocyte function antigen-3 (LFA-3) linked to the Fc portion of human IgG1 Inhibits LFA-3/CD2 interaction, thus inhibits T lymphocyte activation (decreases CD45RO+ T lymphs)