Psoriasis is an autoimmune disease affecting the skin and in some cases also the joints. Its causes are not known although it appears to be at least partly genetic. Factors so far linked to it include smoking, too much stress, and too much alcohol. It causes red scaly patches on the skin where excessive skin cells accumulate and become silvery-white.
These areas are inflamed and itchy. Psoriasis can also impair the toenails and fingernails. It is chronic and difficult to treat.
The drug Raptiva, made by Genentech, has been connected with four cases of Progressive Multifocal Leukoencephalopathy (PML) and of those four, three have caused death. These patients were treated with Raptiva for over three years.
What is PML?
PML is a viral disease that damages the brain in multiple places. People with severe immune deficiency are susceptible to it, such as AIDS patients and those on any immunosuppressive medications. The virus is called the JC virus and is widespread but usually latent. Only when the immune system has been weakened does it cause the disease.
PML causes brain damage by gradually destroying the covering on nerve cells in the brain’s white matter (as opposed to its gray matter). When the covering is destroyed the cell is unable to transmit any nerve impulses. Symptoms include:
- Speech impairment
- Vision loss
- Cognitive deterioration
PML is similar to multiple sclerosis but it progresses more quickly. There is no cure and the median survival period is six months (in AIDS patients).
Raptiva is injected beneath the skin once a week. Its product labeling was updated last October with a boxed warning about the risk of possibly fatal infections. The FDA asked Genentech to do a Risk Evaluation and Mitigation Strategy (REMS) for patient education. On February 19, the FDA issued an advisory describing the four cases and promising to make sure that Raptiva’s risks do not overshadow its benefits.
In psoriasis it is the T-cells that cause the skin inflammation and Raptiva works by suppressing them. That reduces the person’s immune system efficiency, since T-cells normally fight infection.
The National Institutes of Health regards the PML prognosis as “grim”. If you survive you will likely have severe disabilities.
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