Efalizumab

INTRODUCTION

Indications

Moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy.

Action

Inhibits fusion of leukocytes to other cell types resulting in decreased migration of leukocytes to psoriatic areas. Therapeutic Effects: Decreased area and severity of plaque psoriasis.

Adverse Reactions/Side Effects

CNS: headache. Derm: photosensitivity, toxic epidermal necrolysis, worsening of psoriasis. Hemat: hemolytic anemia, thrombocytopenia. MS: arthralgia, arthritis, pain. Misc: MALIGNANCIES, SERIOUS INFECTIONS, fever, first dose reactions, hypersensitivity reactions, inflammatory/immune–mediated reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of malignancy, including a change in bowel or bladder habits, nonhealing sores, unusual bleeding or discharge, a lump in the breast or other parts of the body, chronic indigestion or difficulty in swallowing, obvious changes in a wart or mole, and persistent coughing or hoarseness. Report these signs to the physician immediately.

• Monitor signs of respiratory tract infection (dyspnea, fever, bronchitis, flu-like symptoms), GI infection (nausea, vomiting, diarrhea), or other severe systemic infections. Notify physician immediately because these infections may be severe or fatal, especially in patients taking immunosuppressive therapy.

• Periodically assess the size and appearance of skin lesions to help document whether antipsoriatic drug therapy is successful. Report a worsening of psoriasis or signs of toxic epidermal necrolysis (severe rash, dermatitis, exfoliation).

• Monitor signs of allergic or hypersensitivity reactions, including pulmonary symptoms (laryngeal edema, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician if severe allergic reactions occur.

• Monitor signs of thrombocytopenia (bruising, nose bleeds, bleeding gums) or hemolytic anemia (unusual fatigue, shortness of breath, dizziness, headache, coldness in hands and feet, pale skin, chest pain). Report these signs to the physician immediately.

• Assess any back pain, joint pain, or signs of systemic inflammation. Attempt to differentiate whether pain is drug induced or caused by musculoskeletal or biomechanical problems.

Interventions

• Implement phototherapy (UV light) as indicated to augment drug effects in treating psoriasis. Be especially careful because this drug increases sensitivity to UV light, and a decrease in UV dosage may be necessary.

Patient/Client-Related Instruction

• Advise patient about photosensitivity, and to use sunscreens, protective clothing, and avoid prolonged sun exposure. Advise patient to also report any rashes or other skin reactions.

• Instruct patient to report other side effects such as severe or prolonged headache.

Pharmacokinetics

Absorption: 50% absorbed following SC administration.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.