Apremilast in psoriasis and beyond: Big hopes on a small molecule

Afra, T. P.; Razmi, T Muhammed; Dogra, Sunil

doi:10.4103/idoj.idoj_437_18

Cited by 49 publications

(2 citation statements)

References 86 publications

(91 reference statements)

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“…Furthermore, it dampens the production of pro-inflammatory cytokines such as tumor necrosis factor α (TNF-α) and interleukin-1 (IL-1) [9,10]. Apremilast was approved for the treatment of plaque psoriasis by the United States Food and Drug Administration (US-FDA) in 2014 and the Drug Controller General of India (DCGI) in 2017 [11,12]. Two landmark studies, ESTEEM [13] and PALACE [14], evaluated the efficacy of these drugs in psoriasis treatment and provided inconsonant results.…”

Section: Introductionmentioning

confidence: 99%

Apremilast or Methotrexate: The Arrows in the Quiver for Psoriasis

Panda¹,

Sahoo²,

Mohanty³

et al. 2023

Cureus

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Background and objectives: In the Indian subcontinent, psoriasis cases have skyrocketed in the last decade. Dry and hot weather aggrandizes the annual incidences. Nowadays, dermatologists harness methotrexate and apremilast to manage chronic plaque psoriasis. There needs to be more comparative studies on these drugs. The primary objective was change in Psoriasis Area and Severity Index (PASI) at six months from the baseline. Change in Dermatology Life Quality Index (DLQI) at six months from the baseline and incidences of adverse events served as the secondary objectives.Methods: This randomized, open-label, 24-week study was executed in Srirama Chandra Bhanja (SCB) Medical College, Cuttack, India, from June 2021 to October 2022. The participants were randomized in a 1:1 ratio to receive tablets of either methotrexate 10-15mg weekly once or apremilast 10-30mg twice daily. Efficacy and safety analyses were performed at baseline, eight, 16, and 24 weeks. We used R software (version 4.1.1; R Foundation for Statistical Computing, Vienna, Austria) for data analysis.Results: Seventy (82.3%) of 85 enrolled participants completed the study. The mean age of the study population was 41.08±5.17 years. Twenty-two (31.4%) of them were females. The median change in PASI from baseline was -37.25 (-39.00 to -34.25) for apremilast and -34.75 (-37.75 to -31.75) for methotrexate (p=0.006). The median change in DLQI from baseline was -19.50 (-22.00 to -17.00) for apremilast and -21.00 (-25.50 to -17.50) for methotrexate (p=0.079). No serious adverse events were noticed.Conclusion: Apremilast was more effective than methotrexate in psoriasis treatment. The statistically significant difference was found only in PASI scores.

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Section: Introductionmentioning

confidence: 99%

Apremilast or Methotrexate: The Arrows in the Quiver for Psoriasis

Panda¹,

Sahoo²,

Mohanty³

et al. 2023

Cureus

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“…Apremilast helps to induce weight loss, which indirectly helps both MetS and psoriasis; it has a good safety profile and should be considered in such patients. [ 15 ]…”

Section: Introductionmentioning

confidence: 99%

Psoriasis and its Association with Metabolic Syndrome

Agarwal,

Das,

Kumar

et al. 2023

Indian Journal of Dermatology

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Psoriasis is a multifactorial, chronic, immune-mediated inflammatory condition. Psoriasis often goes beyond the skin, nails and scalp and involves the eyes (uveitis), joints (arthritis) and several metabolic derangements, as seen in various studies. It is strongly associated with features of the metabolic syndrome (MetS) like hypertension, obesity, dyslipidaemia, type 2 diabetes, insulin resistance and non-alcoholic fatty liver disease. Amongst various skin diseases, MetS has the strongest association with psoriasis. The risk of having MetS is almost doubled in patients with psoriasis as compared to healthy individuals. Both conditions share a common pathophysiological background in terms of genetics, inflammatory markers, lifestyle choices, etc. The association of psoriasis with MetS is clinically important as it influences the prognosis, quality of life and choice of treatment. Systemic conventional drugs should be used with caution in such patients, as their long-term use may contribute to metabolic impairment. The treating dermatologist should be aware of such associations and their implications, and a more holistic approach should be taken to manage psoriasis where equal importance is given to lifestyle and dietary modifications and comorbid conditions, in addition to the pharmacological therapy so as to decrease the burden of the disease for both the patient and the health system.

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