Psoriasis treatment: Apremilast

Apremilast is a newer medicine that provides strong treatment for plaque psoriasis and psoriatic arthritis. Unlike other strong medicines for psoriasis, you do not need to have medical tests while taking apremilast.

Why do dermatologists prescribe apremilast?

For people who have plaque psoriasis, this medicine can reduce the:

• Redness

• Thickness 

• Scale

Age and apremilast

In clinical trials, researchers found no differences in the way patients 65 years of age or older and younger patients reacted to apremilast.

Safety and effectiveness

Before receiving approval from the US Food and Drug Agency (FDA), apremilast was studied in more than 4,000 adults with plaque psoriasis, psoriatic arthritis, or both. Most of the side effects that patients experienced during clinical trials were mild.  Few patients with plaque psoriasis stopped taking apremilast due to side effects. Of those who stopped, the most common reasons for stopping were nausea, diarrhea, and headache.

Before taking apremilast, it is important to tell your dermatologist if you: 

• Have ever had depression

• Are pregnant or plan to become pregnant

• Are breastfeeding or plan to breastfeed

• Have any other medical conditions, including kidney disease

• Take any medicine, including ones that you buy without a prescription. Apremilast can interact with some medicines, causing apremilast not to work.

Apremilast works by controlling inflammation in the immune cells. In clinical trials, patients have had the following results.

• Plaque psoriasis: By week 16, about 20% of the patients were clear or almost clear, and about one-third saw 75% or greater improvement.

• Itch: Apremilast greatly reduced the itch for many patients.

• Nail psoriasis: Many patients who had nail psoriasis saw an improvement, with some achieving a 50% reduction in nail psoriasis by week 16. Two-thirds of patients with nail psoriasis continued to see improvement through week 52.

• Scalp psoriasis: More than 40% of patients were clear or almost clear by week 16. 

When the patients with plaque psoriasis stopped taking apremilast, they began to lose the improvements about five weeks after stopping.  Possible side effects: In clinical trials, the most common side effects in people who had plaque psoriasis were:

• Diarrhea

• Nausea

• Headache

• Respiratory tract infection

• Vomiting

• Cold-like symptoms (runny nose and sneezing)

The clinical trials ran for one year, so the long-term effects of taking apremilast are unknown. 

How to use

Apremilast is a pill that you take twice a day.  To reduce the possibility of having side effects, you slowly increase the dose during the first week. By day 7, most patients take the full dose, which involves swallowing one pill in the morning and one pill 12 hours later.

Swallow apremilast whole

It’s important to swallow the pills whole rather than crushing, splitting, or chewing them.

You can take apremilast with meals, but it’s not necessary.

What to discuss with your dermatologist

In clinical trials, some patients became depressed or noticed that an existing depression worsened. A few patients had suicidal thoughts while taking apremilast. Other patients had unexplained weight loss.   You should tell your dermatologist if you:

• Have symptoms of depression, especially if you have suicidal thoughts

• Notice any other mood changes

• Lose weight without trying or lose a noticeable amount of weight

• Experience any other side effect

Images
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References
Fala, L “Otezla (Apremilast), an Oral PDE-4 Inhibitor, Receives FDA Approval for the Treatment of Patients with Active Psoriatic Arthritis and Plaque Psoriasis.” Am Health Drug Benefits. 2015 Mar; 8(Spec Feature): 105–110.

Marks, B. “More than skin deep: Triggers, treatments, and you.” An educational session hosted by the National Psoriasis Foundation. Chicago: Presented June 20, 2015.

Papp K, Reich K, et al. “Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: Results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1).” J Am Acad Dermatol. 2015 Jul;73:37-49.

Rich, P, Gooderham M, et al. “Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with difficult-to-treat nail and scalp psoriasis: Results of 2 phase III randomized, controlled trials (ESTEEM 1 and ESTEEM 2).” J Am Acad Dermatol2016 Jan; 74:134-42.