Alefacept is indicated for the treatment of moderate to severe plaque psoriasis and is administered as a course of 12 weekly intramuscular injections. The requirement for in-office administration of alefacept prevents the use of the drug for some patients who do not wish to visit the dermatologist weekly. For this reason, a patient of mine agreed to self-administer the intramuscular preparation of alefacept as a once-weekly subcutaneous injection.
A 34-year-old woman presented with a 20-year history of chronic unremitting plaque psoriasis. The patient also had a history of multiple sclerosis, for which she had received intramuscular interferon beta-1a. She had discontinued the interferon beta-1a therapy 10 weeks previously. She denied any other medical problems and took no other medications. Her treatment history included UV phototherapy, topical corticosteroids, and topical calcipotriene. At presentation, her Psoriasis Area Severity Index was 9.0, with plaque psoriasis involving 10% of her body surface area, including her scalp, trunk, and extremities. Her baseline CD4 count was 689 cells/μL.