Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavanagh, PhD, PA-C


Objective: The objective of this selective EBM review is to determine whether or not high dose intramuscular alefacept is a more effective and a safe treatment option in visibly reducing the severity of chronic plaque psoriasis in men and women 16 years and older compared to standard IV and IM treatment forms.

Study Design: Review of three dichotomous data, English language, and primary randomized controlled trials published 2003 – 2008.

Data Sources: Randomized, controlled clinical trials comparing alefacept to a control
group were found using PubMed database.

Outcome Measured: Disease improvement and the adverse effect of headache. Disease
improvement was measured using the Physician’s Global Assessment (0=clear, 5=severe)
and the Psoriasis Area and Severity Index (0 = no disease, 72 = maximal disease).
Numbers needed to treat were calculated for efficacy and numbers needed to harm was calculated to determine safety.

Results: The efficacy, based on NNT, of high dose alefacept, 30 mg IM was calculated based on Cafardi et al’s trial to be 8 compared to Krueger’s trial of 4, and Ortonne’s 5. NNH for headaches were calculated to be -8 for Cafardi et al, -100 from Krueger, and 34 from Ortonne.

Conclusion: After researching the three randomized control trials, alefacept 30 mg IM weekly for 12 weeks does not provide more effective results when treating chronic plaque psoriasis compared to standard doses of 7.5 mg IV or 15 mg IM weekly. Headaches were also seen more commonly as an adverse effect with high dose alefacept. As a result, standard doses of the biologic agent should be continued to be used to treat chronic plaque psoriasis that does not respond to other interventions and more studies must be further performed with alefacept 30 mg IM weekly.