Failure of Alefacept in the Treatment of Vitiligo
February 2013 | Volume 12 | Issue 2 | Original Article | 159 | Copyright © 2013
Salman Bin Dayel MDa and Khalid AlGhamdi MDb
aDepartment of Dermatology, Salman Bin Abdulaziz University, Alkarj, Saudi Arabia bDepartment of Dermatology, King Saud University, Riyadh, Saudi Arabia
Background: Vitiligo is a common acquired pigmentary disorder with a profound psychosocial impact. The exact pathogenesis of vitiligo is not fully understood; however, vitiligo appears to be an autoimmune disease involving T-cell-mediated melanocyte destruction. Recently, complete clearance of coexisting vitiligo without recurrence over 2 years was reported in 2 psoriasis patients treated with alefacept.
Objective: To evaluate the safety and efficacy of alefacept in the treatment of vitiligo.
Methods: After providing informed written consent, 4 adult patients with widespread vitiligo (covering a body surface area ≥5%) were treated with weekly intramuscular injections of 15 mg alefacept for 12 weeks. All patients were monitored clinically, by laboratory investigation, and by digital image analysis. All patients were followed up with for 24 weeks.
Results: All patients tolerated alefacept well, without any adverse events. None of the patients showed any repigmentation. However, 1 patient developed new depigmented patches during treatment with alefacept.
Limitations: A pilot study with a small number of patients.
Conclusion: Alefacept as a monotherapy for vitiligo treatment did not result in any patient improvement, and further evaluation in larger studies may be required.
J Drugs Dermatol. 2013;12(2):159-161.
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Vitiligo is a common acquired pigmentary disorder with a profound psychological impact. It has been reported to affect approximately 1% of the population worldwide, irrespective of skin color or ethnic origin.1 Vitiligo can be cosmetically and psychologically devastating, resulting in low self-esteem, poor body image, and difficulties in sexual relationships. 2-4 Because the disease is not well understood, several theories have been proposed to explain the loss of epidermal melanocytes in this disorder, including autoimmune, biochemical, oxidant–antioxidant, neural, and viral mechanisms.5 An autoimmune hypothesis for vitiligo pathogenesis has been supported by both experimental data and clinical association with autoimmune diseases.6-8 Because the disorder is not fully understood, a plethora of different treatments are available, with variable results. Vitiligo improvement was reported in 2 patients who were treated with alefacept because of coexisting psoriasis.9 The aim of this pilot study is to evaluate the efficacy and safety of alefacept in the treatment of widespread vitiligo.
Four adult patients with widespread vitiligo (covering a body surface area of ≥5%) were recruited from our dermatology clinic. All patients had nonstable vitiligo and had not received any treatment for vitiligo for the past 6 months. All patients gave their written informed consent. This pilot study had been approved by the Research Ethics Committee, Vitiligo Research Chair, King Saud University.
Patient data and treatment results are summarized in Table 1.
Treatment With Alefacept
Baseline complete blood counts, differential leukocyte counts, liver function test, renal function test, thyroid function test, fasting blood sugar, antinuclear antibodies, and chest radiographs were all within normal limits for all patients. CD4 counts were monitored before and biweekly during treatment with alefacept and were within normal limits throughout the treatment. Alefacept was administered to all patients as 15-mg weekly intramuscular injections for 12 weeks. The response was assessed by investigators through visual comparison of photos obtained by digital camera at baseline and at 6, 12, and 24 weeks. All patients completed the treatment plan and were followed up with for 24 weeks.
Alefacept was well tolerated during the treatment period, and none of the patients reported any adverse events. All digital images were compared before, during, and after treatment. In all patients, there was no repigmentation of the affected areas. One patient (patient 2) developed new depigmented patches during treatment period, but vitiligo was stable in the other 3 patients (Figures 1 and 2).
Vitiligo is an acquired dyschromia of the skin in which there is a loss of epidermal melanocytes. Although the precise pathogenesis is not fully understood, vitiligo appears to be an autoimmune disease involving the T-cell–mediated destruction of melanocytes.10,11 Although the triggers and specific nature of the autoimmune response remain unknown, circulating autoantibodies to melanocytes and various melanocytic protein