One stone, two birds: Improvement of early‐onset vitiligo under apremilast in a patient with plaque psoriasis

Plachouri, Kerasia‐Maria; Kyriakou, Georgia; Chourdakis, Vlassios; Georgiou, Sophia; Grafanaki, Katerina

doi:10.1111/dth.13064

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…The patient experienced fairly significant re-pigmentation and reported around 70% improvement on 11 months of treatment with apremilast at 30mg twice daily and two shots of 60mg triamcinolone, first at three months a repeat shot at 4.5 months of treatment [16]. Another case of a 59-year-old man with vitiligo and psoriasis reported clearance of almost all psoriatic lesions and re-pigmentation of the hypopigmented patches on the neck and lower face after six months of treatment with apremilast [17].…”

Section: Discussionmentioning

confidence: 99%

Apremilast Add-On Benefits Over Conventional Drugs (ABCD) in Unstable Non-segmental Vitiligo: A 12-Week Single-Center Randomized Controlled Trial

Sharma¹,

Bhardwaj²,

Dwivedi³

et al. 2023

Cureus

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BackgroundApremilast is an oral phosphodiesterase-4 enzyme inhibitor that modulates the immune system by increasing intracellular cyclic adenosine monophosphate levels and inhibiting inflammatory cytokines synthesis. We aimed to compare the efficacy and safety of add-on apremilast in combination therapy with standard treatment in patients with unstable, non-segmental vitiligo. MethodsThe study was a 12-week randomized, controlled, parallel-group, open-labeled trial. The control group received standard treatment (n=15), and the intervention group received 30 mg apremilast twice daily in addition to standard treatment (n= 16). Time to the first sign of re-pigmentation, halt in progression, and change in vitiligo area scoring index (VASI) score is the primary outcomes. Normality was assessed, and appropriate parametric and nonparametric tests were undertaken. ResultsThirty-seven participants were randomized into two groups, and analysis was done on thirty-one participants. Over the treatment duration of 12 weeks, the median time to observe the first sign of repigmentation was four weeks in the add-on apremilast group compared to seven weeks in the control group (p=0.018). The halt in progression was observed more in the add-on Apremilast group (93.75%) compared to the control group (66.66%) (p=0.08). The VASI score decreased by 1.24 in the add-on apremilast group and 0.05 in the control group (p= 0.754). Parameters including body surface area, dermatology life quality index, and body mass index reduced significantly, while the visual analog scale increased significantly in the addon apremilast group. However, results were comparable between groups. ConclusionsTreatment with add-on apremilast accelerated clinical improvement. It also reduced disease progression and improved the disease index among participants. However, add-on apremilast had a lower tolerability profile than the control group.

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Section: Discussionmentioning

confidence: 99%

Apremilast Add-On Benefits Over Conventional Drugs (ABCD) in Unstable Non-segmental Vitiligo: A 12-Week Single-Center Randomized Controlled Trial

Sharma¹,

Bhardwaj²,

Dwivedi³

et al. 2023

Cureus

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“…A few case reports have reported vitiligo stabilization and repigmentation with apremilast therapy. 6,7 Alopecia areata Several case reports 8,9 have reported hair regrowth with apremilast in patients with refractory alopecia areata (AA) but larger studies have failed to replicate these findings (Table 4). Mikhaylov et al conducted an RCT that recruited 30 patients with moderate to severe AA to receive either apremilast (n = 20) or placebo (n = 10).…”

Section: Vitiligomentioning

confidence: 99%

“…The highest reduction in VASI was observed in the apremilast and NB‐UVB combination group, followed by the NB‐UVB monotherapy group, with the apremilast monotherapy group showing the least degree of repigmentation. A few case reports have reported vitiligo stabilization and repigmentation with apremilast therapy 6,7 …”

Section: Off‐label Dermatological Uses Of Apremilastmentioning

confidence: 99%

Evolving utility of apremilast in dermatological disorders for off-label indications

Mehta

Sharma

Dogra

2022

Clinical and Experimental Dermatology

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Apremilast, a small molecule that acts by inhibition of the phosphodiesterase‐4 enzyme, has been approved by the US Food and Drug Administration for the management of psoriatic arthritis, plaque psoriasis and Behçet disease. The drug has drawn much interest from practising dermatologists in view of its exceptional safety profile and prescription convenience, as evident by the recent surge of literature describing its off‐label indications. This review was carried out with the aim of summarizing the literature on off‐label use of apremilast in dermatology, in order to guide clinicians regarding currently available evidence. The PubMed database was searched using ‘apremilast’ as a keyword in the title. Abstracts were individually screened to determine whether there was a description of an off‐label use of apremilast in dermatology within the article. Randomized controlled trial data were available for vitiligo, alopecia areata, hidradenitis suppurativa and atopic dermatitis. Case series and case reports describing apremilast were also reviewed. Owing to its broad spectrum of immunomodulatory activity, apremilast may be useful in several chronic inflammatory skin diseases recalcitrant to conventional therapies, either alone or in combination with other drugs. Further studies are needed to establish its role in various dermatological indications.

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“…64 Additional case reports have found improvement in both recalcitrant acral and generalized vitiligo without lasting or serious TEAEs. 65,66 Case series and reports detailing efficacy of apremilast for off-label dermatoses Palmoplantar pustulosis Although once considered a subtype of palmoplantar psoriasis, beginning in 2007 palmoplantar pustulosis has been deigned its own entity. 67 Although several studies, including RCTs and open-label trials, have shown efficacy for multiple biologic and nonbiologic therapies for palmoplantar psoriasis, there is less rigorous information for palmoplantar pustulosis, including with regards to apremilast.…”

Section: Rosaceamentioning

confidence: 99%

“…41,42,47,55,57,68,69,70,72,75,81,84,87,91,93 Furthermore, studies that investigated changes in known cytokine cascades suggest that apremilast and PDE-4 inhibition may achieve its efficacy by targeting inflammatory mediators unaffected or not primarily affected by current first-line agents. [36][37][38][39][40]42,43,46,49,54,55,58,59,65,66,[81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96] In addition to efficacy, consideration should be given to apremilast's safety profile. While gastrointestinal TEAEs (most commonly nausea, diarrhea, vomiting), weight loss and headache do occur, they are often transient or manageable with dose modification.…”

Section: Additional Dermatosesmentioning

confidence: 99%

Apremilast as an Off-Label Therapeutic Agent

Marson

Lebwohl

2021

J of Skin

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Objective: To review the literature regarding the efficacy and safety of off-label use of apremilast in combination therapies for psoriasis and psoriatic arthritis and for other currently off-label inflammatory dermatoses. Methods: The Medline database was queried for all relevant articles published between 2014 and 2021 using exploded MeSH terms and keywords pertaining to the following themes: off-label, combination therapy, biologics, biologic therapy, methotrexate, and systemic psoriasis therapy. The Boolean term “AND” was used to find the intersection of these themes with the term “apremilast.” Results: 8 case series and 6 case reports investigated the use of apremilast in combination therapy for psoriasis and psoriatic arthritis. Addition of apremilast improved PASI scores by 31.8-77.4% among case series and 80-100% among case reports with adverse effects primarily consisting of gastrointestinal symptoms. 5 randomized-control trials (RCT), 9 open-label trials, 18 case series, and 30 case reports investigated the use of apremilast for off-label dermatoses. In RCTs, apremilast showed potential efficacy for atopic dermatitis and hidradenitis suppurativa. Open-label trials found apremilast efficacious for atopic dermatitis, allergic contact dermatitis, chronic pruritus, cutaneous sarcoidosis, discoid lupus erythematosus, hidradenitis suppurativa, lichen planus, prurigo nodularis, rosacea, and vitiligo. Limitations: Small sample size and short follow duration up for available randomized-control and open-label trials. Current data from case series/reports potentially limits generalizability of findings. Conclusion: Apremilast's safety profile makes it a potential efficacious, non-biologic systemic agent for monotherapy and combination therapy for a wide range of inflammatory dermatoses.

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One stone, two birds: Improvement of early‐onset vitiligo under apremilast in a patient with plaque psoriasis

Cited by 5 publications

References 8 publications

Apremilast Add-On Benefits Over Conventional Drugs (ABCD) in Unstable Non-segmental Vitiligo: A 12-Week Single-Center Randomized Controlled Trial

Apremilast Add-On Benefits Over Conventional Drugs (ABCD) in Unstable Non-segmental Vitiligo: A 12-Week Single-Center Randomized Controlled Trial

Evolving utility of apremilast in dermatological disorders for off-label indications

Apremilast as an Off-Label Therapeutic Agent

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