Long‐term efficacy and safety of apremilast in psoriatic arthritis: Focus on skin manifestations and special populations

Abstract

Few real‐life studies evaluated long‐term apremilast therapy in the variable spectrum of clinical‐anamnestic features which can be found in psoriatic arthritis (PsA) patients. This real‐life retrospective observational study aimed to assess long‐term efficacy, safety, and tolerability of apremilast among patients with PsA and concomitant cutaneous psoriasis. A stratified analysis was performed on special populations, defined as (a) number (≤1 vs >2) of comorbidities, presence or absence of: (b) history of malignancy, and (c) previous exposure to biologics. Patients attending three Italian University and Hospital centers, who received at least one dose of apremilast and had at least one follow‐up visit were included. Ninety‐six patients with PsA were identified. Psoriasis Area and Severity Index (PASI), Body Surface Area, 28‐joint Disease Activity Score, and Dermatology Life Quality Index scores improved during treatment, already at week 4, relative to baseline. More than 2 comorbidities, history of malignancy and previous biologic treatment negatively influenced PASI responses. At least one adverse event was experienced by 56/96 patients, and 11/56 events required drug withdrawal. In conclusion, this study confirm efficacy and safety of apremilast on joints and skin involvement of PsA, highlighting which patients could have less favorable treatment response.

Comorbidities burden and previous exposure to biological agents may predict drug survival of apremilast for psoriasis in a real‐world setting

“…6 In the latter study, apremilast use in patients with more than 2 comorbidities, history of cancer and prior use of biological agents presented a less favorable treatment response in PsA cutaneous manifestations with a negative influence in PASI responses. 6 Noteworthy in our study none of these patients had any history of cancer or latent tuberculosis infection prior to the initiation of treatment.…”

“…A good profile of efficacy and safety of apremilast was shown in a retrospective study of 23 elderly patients requiring systemic treatment for moderate‐to‐severe psoriasis 5 as well as in a real‐life study of 96 patients with psoriatic arthritis (PsA) 6 . In the latter study, apremilast use in patients with more than 2 comorbidities, history of cancer and prior use of biological agents presented a less favorable treatment response in PsA cutaneous manifestations with a negative influence in PASI responses 6 . Noteworthy in our study none of these patients had any history of cancer or latent tuberculosis infection prior to the initiation of treatment.…”

New pharmacotherapy options for noninfectious posterior uveitis

“…Initially, it has been proposed as a treatment for depression and multiple sclerosis but never approved for those diseases. Apremilast (Celegene Corporation) has been approved since 2014 for psoriatic arthritis and plaque psoriasis [ 91 , 92 ]. An extension for the treatment of patients with oral ulcers associated with Behçet’s disease is currently pending.…”

Experimental Pharmacological Management of Psoriasis

“…77 In this context, JAKsI may be employed in the treatment of psoriasis as they oppose to the immune-mediated mechanisms underlying psoriasis. 69 In particular, as JAK-STAT pathway activation, induced by IL-23, upregulates STAT3, 5 JAKsI down-regulate IL-17 and IL-17F transcription, which are critical for Th17 lymphocytes development. 16 Among JAKsI, daucravacitinib, with its unique ability to selectively inhibit TYK2 promises to target specific cytokine pathways, involving IL-12, IL-23, and IFN, arousing great interest for increasing target specificity and reducing AEs.…”

“…4 Alongside the common disease modifying anti-rheumatic drugs, several classes of biologicals and small molecules are now used in the systemic treatment of psoriasis. 5,6 Phosphodiesterase (PDE) 4 inhibitors are largely known to improve both skin and joint disease, modulating, at the same time, metabolic biomarkers in diabetic psoriatic patients, with the chance to be employed in psoriatic patients with cardio-metabolic comorbidities. 7,8 Moreover, the small molecules showed strong efficacy also in nail psoriasis, which is known as a difficult-to-treat form of the disease.…”