Efalizumab - Raptiva

What is Raptiva?
Raptiva is a biological medication approved by the European Agency for the Evaluation of Medicinal Products (EMEA) in October 2004 for the treatment of moderate to severe psoriasis.

Key Features
• Approved for treating psoriasis
• Patients give themselves an injection once a week under the skin.
• Patients must continue to take the treatment to maintain results.
• It may be necessary to have occasional blood tests.
• Long term side effects are still being monitored.

How does it work?
Raptiva works by blocking the activation of certain immune cells called ‘T-cells’ and the migration of those cells into the skin. T cells are a type of white blood cell in the body that normally help us to ward off foreign invaders and fight infection. In psoriasis, however, these T cells are mistakenly activated and there are too many of them in the skin. This triggers other immune responses that fuel the development of psoriasis lesions. By blocking T cell activation and the movement of these cells into the skin, Raptiva interrupts the cycle of psoriasis leading to improvement in symptoms.

Who is it for?
Raptiva is indicated for the treatment of adult patients with severe chronic plaque psoriasis who have failed to respond to, or who have a contraindication to, or are intolerant to other systemic therapies including etanercept (enbrel), ciclosporin, methotrexate and PUVA.
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Who should not take Raptiva?
• People taking vaccines or with serious active infections should not start Raptiva.
• Children - the medication has not been approved for children.
• Patients with a history of malignancies.
• Patients with specific forms of psoriasis like guttate, erythrodermic or pustular psoriasis as sole or predominant form of psoriasis.
• Patients with immunodeficiencies.
• Pregnant women should not be treated with Raptiva and women should not breast feed during treatment with Raptiva.

How is it used?
Patients take Raptiva at home once per week by giving themselves an injection under the skin, similar to diabetes patients. The medication, information and required equipment will be delivered to the patient’s home by a nurse from Healthcare at Home. Dosing is determined by body weight and it is likely that a smaller dose will be given for the first injection to help the body become accustomed to the medication. The Healthcare at Home nurse will give full instructions.
Raptiva is designed to be taken continuously to maintain improvement. In the studies the symptoms of psoriasis returned in one or two months after treatment was stopped. A small percentage of people may experience a flare up of psoriasis if Raptiva is stopped abruptly. This risk is reduced if the patient is tapered off Raptiva slowly or switched to another treatment.
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What are the side effects?
The most frequent side effects reported in clinical studies were – headache, infections (usually upper respiratory infections), chills, nausea, flu syndrome, fever.
These events were most often reported after the first dose of Raptiva and may decrease after additional doses. These side effects are generally mild and did not cause most patients to stop taking Raptiva.
Raptiva does suppress the immune system which means it has the potential to increase the risk of infection. The most serious side effects were rare but included psoriasis relapse, serious infections and thrombocytopenia (low platelet counts). Blood tests for the assessment of platelet counts is recommended when Raptiva is started and periodically thereafter.
There was not an increase in the number of malignant growths or lymphomas compared to placebo in the initial studies although it is unknown whether long term use of Raptiva will result in an increased chance of developing malignancies.

How do I get Raptiva?
Raptiva will only be prescribed by a Consultant Dermatologist in a hospital dermatology department. It will only be prescribed for those patients for whom all other treatments have failed or are contraindicated.
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