Apremilast in the treatment of psoriatic arthritis: a perspective review

Abstract

Abstract:Apremilast is an orally-active small molecule which inhibits phosphodiesterase-4 (PDE4). Clinical trials have demonstrated its efficacy and safety in psoriatic arthritis (PsA) and psoriasis. Established therapeutic options have variable effectiveness across the different domains of psoriatic disease. Whilst biologic therapies have proven to be of significant benefit to many patients, not all patients respond, and others are not eligible or do not tolerate biologic therapy. We review the mechanism of action, pharmacokinetics and clinical trial data with regards to both efficacy and safety for apremilast and consider where this new treatment may be positioned in the treatment of PsA.

Consensus on the management of patients with psoriatic arthritis in a dermatology setting

“…All biologic agents have been shown to slow radiographic damage in patients with PsA who have peripheral joint involvement. Apremilast is an oral phosphodiesterase 4 (PDE4) inhibitor, indicated in the treatment of PsO and PsA . Skin and joint responses to treatment with apremilast are somewhat lower than those observed with biologic agents, and apremilast has not been investigated in the prevention of structural damage.…”

Psoriatic arthritis with skin lesions localized to the scalp: A case report

“…Patients with PsA are often treated with nonsteroidal anti‐inflammatory drugs (NSAIDs), oral disease‐modifying antirheumatic drugs (eg, methotrexate), or the injection of monoclonal antibodies (eg, tumor necrosis factor inhibitors). Oral administration of apremilast is also a useful therapeutic strategy in these patients 11 . Axial involvement, represented by axial spondyloarthritis or active enthesitis, usually requires further treatments with monoclonal antibody therapies after NSAIDs administration; therefore, careful physical examination is important including axial joint evaluation (spine and sacroiliac joints) and/or imaging studies to detect active enthesitis 12 .…”

<p>An Update for the Clinician on Biologics for the Treatment of Psoriatic Arthritis</p>

“…On the contrary, the efficacy of APR is lower than it would be anticipated with biologic therapies as ADA. 98 Another indirect comparison indicates that APR, SEC, and UST may have similar efficacy in patients with PsA and an inadequate response to TNFi. 112 GRAPPA guidelines strongly recommended bDMARDs and APR in patients with peripheral arthritis and an inadequate response to csDMARDs.…”

“…PDE4 inhibition produces increased cAMP levels in immune and non-immune cells, altering the expression of downstream cascades and modifying inflammatory responses. 98 , 99 Apremilast (APR) is an oral small molecule that inhibits intracellular PDE4 approved in March 2014 for the treatment of adult patients with PsO and active PsA. 100 The efficacy and safety of APR were firstly demonstrated in four Phase III, placebo-controlled studies (PALACE 1, 2, 3, and 4).…”