Raptiva
What is Raptiva?
Raptiva (also known by its generic name efalizumab) is a biologic medication approved in October 2003 by the U.S. Food and Drug Administration (FDA) for treating moderate to severe plaque psoriasis. For more information about biologics as a class of treatment, please see the biologics section.
Key features
- FDA-approved for treating psoriasis
- Patients give themselves an injection under the skin once per week
- Taken continuously to maintain results
- Occasional blood tests may be recommended
- Long-term side effects still being evaluated
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; in psoriasis, once these T cells are mistakenly activated, they can trigger inflammation and other immune responses and 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 for many people who take it.
Who is a candidate?
Raptiva is prescribed for adults with moderate to severe plaque psoriasis who are candidates for phototherapy or
other systemic (oral or injected) treatments. Patients do not have to try or fail other medications before being prescribed Raptiva.
Who should not take Raptiva?
- People taking vaccines or with active serious infections should not start Raptiva
- Children—the medication has not been approved for children
Caution is advised for the elderly, due to the already increased risk of infection for this age group.
The impact of Raptiva on pregnant women or developing fetuses is not known, nor is it known if
the medication passes into breast milk in nursing women. Raptiva should only be given to pregnant or nursing women if there is a clear medical need, and if this decision is reached by a patient and doctor together. Pregnant women using Raptiva should talk to their doctor about enrolling in the Raptiva pregnancy registry.
How is it used?
Patients take Raptiva at home once per week by giving themselves an injection under the skin, similar to diabetes patients who give themselves insulin injections. Dosing is determined by body weight; a smaller dose is given for the first injection to help the body become accustomed to the medication.
Raptiva is designed to be taken continuously to maintain improvement. In the clinical studies, the symptoms of psoriasis returned in one or two months after treatment was stopped.
There have been rare reports of patients experiencing a flare or rapid return of psoriasis after they stopped taking Raptiva. Depending on how the flare is measured, between 5 percent and 13 percent of people may experience this kind of reaction if they stop Raptiva abruptly. However, this risk may be reduced if the patient is tapered off Raptiva slowly or is switched to another psoriasis treatment. It is important to work with your doctor when stopping Raptiva.
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
- back pain
- acne
These side effects were generally mild and did not cause most patients to stop taking Raptiva. These events happened most often after the first dose of Raptiva and may decrease after additional doses.
In particular, a group of reactions (headache, fever, chills, nausea and muscle pain) occurred most commonly after the first one or two injections of Raptiva during the initial 12-week treatment. With this in mind, a smaller "conditioning" dose is recommended for the first treatment to reduce the severity and occurrence of these side effects. By the third injection, side effect rates were similar to those taking placebo.
Raptiva does suppress the immune system, which means it has the potential to increase the risk of infection. The most serious side effects were very rare, but included psoriasis relapse (see "How is it used?" section above), serious infections and thrombocytopenia (low platelet counts). Assessment of platelet counts is recommended when Raptiva treatment is started and periodically thereafter, but such monitoring is not required. People taking Raptiva who notice a worsening of psoriasis or increased bruising or bleeding should contact their doctor right away.
There was no 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.
Raptiva's safety and side effects continue to be monitored by Raptiva's manufacturer Genentech, and the FDA.
For detailed information on side effects and safety, talk to your doctor.
How do I get Raptiva?
Raptiva is available by prescription, primarily from dermatologists. Once a person and his or her doctor make the decision that Raptiva is an appropriate treatment, a determination of insurance coverage will need to be made, and preauthorization from the insurance company will likely be needed.
Genentech has a special program where patients and doctors can get help with insurance questions and other issues. For more information, call 877.RAPTIVA (877.727.8482) or visit www.raptiva.com.
The link above takes you off the Psoriasis Foundation Web site. The Psoriasis Foundation does not endorse or accept any responsibility for the content of external Web sites. Click here for complete terms of use.
How much does it cost?
In general, biologics tend to be expensive; the cost of each drug can vary between $10,000 and $25,000 per year (or more), based on the dosage and treatment regimen prescribed by your doctor. Most insurance companies cover this medication for its approved indication: psoriasis. If a person's health insurance will cover Raptiva, the exact amount will vary. Some patients may be fully covered for Raptiva; others may be partially covered or, in some cases, may have to pay a percentage of the total cost out of pocket.
Genentech has a patient assistance program to help provide discounted medications to people who qualify, based on income levels and other factors. For more information about this program, call 877.RAPTIVA (877.727.8482).
Updated March 2008
Some of the links above take you off the Psoriasis Foundation Web site. The Psoriasis Foundation does not endorse or accept any responsibility for the content of external Web sites. Click here for complete terms of use.
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