Alefacept

Indications

Alefacept is used for: Psoriasis

Adult Dose

Psoriasis Indicated for moderate-to-severe chronic plaque psoriasis 15 mg given once weekly as an intramuscular injection for 12 weeks A regimen of 12 weekly injections recommended Re-treatment with an 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

Lymphopenia: Induces dose-dependent reductions in circulating CD4+ and CD8+ T lymphocyte counts Malignancies: May increase the risk of malignancies. Do not administer to patients with a history of systemic malignancy Serious Infections: Alefacept may increase the risk of infection and reactivate latent, chronic infections. Do not administer to patients with a clinically important infection. Monitor new infections closely Potential for excessive immunosuppression when used with other immunosuppressive agents or phototherapy Hypersensitivity Reactions: Urticaria and angioedema have been associated with the administration of Alefacept Hepatic Injury: Post-marketing reports of liver injury. Discontinue use in patients who develop clinical signs of liver injury Monitoring Parameters: Monitor CD4+ T lymph counts weekly; withhold dosing if CD4 <250/mcL; discontinue if CD4 <250/mcL for one month

Pregnancy-Lactation

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

Interactions

Contraindicated (0) Serious - Use Alternative (68) adalimumab adenovirus types 4 and 7 live, oral anakinra anthrax vaccine antithymocyte globulin equine antithymocyte globulin rabbit axicabtagene ciloleucel azathioprine basiliximab BCG vaccine live brexucabtagene autoleucel canakinumab ciltacabtagene autoleucel diphtheria & tetanus toxoids diphtheria & tetanus toxoids/ acellular pertussis vaccine diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine etanercept everolimus glatiramer golimumab hepatitis A vaccine inactivated hepatitis a/b vaccine hepatitis a/typhoid vaccine hepatitis b vaccine human papillomavirus vaccine, nonavalent human papillomavirus vaccine, quadrivalent hydroxychloroquine sulfate idecabtagene vicleucel infliximab influenza virus vaccine quadrivalent influenza virus vaccine quadrivalent, adjuvanted influenza virus vaccine quadrivalent, cell-cultured influenza virus vaccine quadrivalent, intranasal influenza virus vaccine trivalent influenza virus vaccine trivalent, adjuvanted Japanese encephalitis virus vaccine leflunomide lisocabtagene maraleucel measles (rubeola) vaccine measles mumps and rubella vaccine, live measles, mumps, rubella and varicella vaccine, live meningococcal A C Y and W-135 polysaccharide vaccine combined muromonab CD3 mycophenolate pneumococcal vaccine 13-valent pneumococcal vaccine heptavalent pneumococcal vaccine polyvalent rabies vaccine rabies vaccine chick embryo cell derived rilonacept rotavirus oral vaccine, live rubella vaccine sirolimus smallpox (vaccinia) vaccine, live tacrolimus temsirolimus tetanus toxoid adsorbed or fluid tick-borne encephalitis vaccine tisagenlecleucel tocilizumab tongkat ali travelers diarrhea and cholera vaccine inactivated typhoid polysaccharide vaccine typhoid vaccine live ustekinumab varicella virus vaccine live yellow fever vaccine zoster vaccine live

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)