Medco Health Solutions, Inc.
To initiate a Coverage Review, Call 1 800 753-2851
Alefacept injection (Amevive
Efalizumab injection (Raptiva
Refer to separate summaries for adalimumab (Humira
), etanercept injection (Enbrel
) and infliximab injection
) for more information on the coverage policies for those medications.
What They Do and How They Are Used
Plaque psoriasis is a chronic skin disorder characterized by red, scaly, raised lesions that tend to form on
the scalp, limbs, back and genitalia. Chief complaints of patients with moderate to severe psoriasis include
scaling, itching, redness and tightness of the skin with burning sensations. Exposed skin, especially
cracked or bleeding areas, can act as potential sites of infection.
Psoriasis is equally common in men and women, and it has a bimodal peak of onset. The largest peak
occurs between 20 and 30 years of age, and a smaller peak is noticed between 50 and 60 years of age.
Psoriasis is recognized as an immune system–mediated disease. Plaques consist primarily of T-cells,
which are responsible for starting the changes seen in psoriasis and the maintenance of skin plaques.
Plaques also contain a high level of tumor necrosis factor (TNF). TNF is a naturally occurring cytokine that
is involved in normal inflammatory and immune responses.
Initial treatment for stable plaque psoriasis is topical, including corticosteroids, emollients, anthralin, tar,
retinoids, calcipotriene (vitamin D analogue) and salicylic acid. Though corticosteroids are the mainstay of
topical therapy, continuous use of these agents can cause tachyphylaxis (wearing-off effect) and several
side effects. Other treatments for plaque psoriasis include phototherapy, immunosuppressants and
Biological treatments such as Amevive
are used either after
these conventional treatments have failed in continuing to provide benefit or when a patient is