Dr Whitmore's letter regarding our report on intramuscular alefacept raises several questions. One question concerns the durability of placebo response. A small proportion of placebo-treated patients undoubtedly undergo lasting spontaneous remissions of psoriasis, and a comparably small proportion of alefacept-treated patients experience spontaneous remission of their disease as well. The difference between the 2 groups should be considered when evaluating the durability of response. Certainly, there is a significantly greater response that is longer lasting in the alefacept-treated patients than in the placebo-treated patients.
Lebwohl M. Appropriate Use of Alefacept Therapy for Psoriasis. Arch Dermatol. 2004;140(2):239-240. doi:10.1001/archderm.140.2.240-a