Possibility of combined therapy with an oral phosphodiesterase-4 inhibitor (apremilast) and dihydrofolatereductase inhibitor (methotrexate) in patients with psoriatic arthritis plaque psoriasis

Abstract

Background: Data on the possible combinations of apremilast with other types of psoriasis therapy is limited.
 Description of clinical cases: We present the data on the efficacy and safety of combination therapy of the selective phosphodiesterase 4 inhibitor and dihydrofolatereductase inhibitor (methotrexate) for the treatment of psoriasis and psoriatic arthritis in patients with moderate-to-severe plaque psoriasis and active psoriatic arthritis with lack of efficacy of methotrexate in the anamnesis. The selective phosphodiesterase 4 inhibitor (apremilast) was administered according to the prescription. The severity psoriatic arthritis of was estimated by PASI. The effectiveness of therapy was evaluated at week 14. Due to the lack of effect, methotrexate was added subcutaneously at week 14. The effectiveness of combination therapy was assessed at week 26. In both cases, the significant clinical improvement was reached (patients reached PASI 75 and PASI 90), a decrease of the psoriatic arthritis activity according to the DAS28 and DAPSA.
 Conclusion: These clinical cases demonstrate the efficacy and safety of combined therapy with methotrexate and apremilast inpatients with active psoriatic arthritis and moderate to severe plaque psoriasis.

Expression Dynamics Of Cytokine Genes Is Related To The Apremilast Treatment Effectiveness In Patients With Severe Psoriasis

“…Clinical characteristics of the patients such as phenotype classification, exclusion and inclusion criteria, clinical assessment of psoriasis severity including Psoriasis Area and Severity Index (PASI) score, and targeted therapy for psoriasis using apremilast were assessed as previously described [16,17].…”

“…In addition, its use provides some improvement in the condition of patients with psoriatic arthritis [13], has a beneficial effect on biologically unresponsive patients [14] and on the comorbidities of psoriasis [15], along with improving the treatment of psoriasis with methotrexate [16]. Safety profile of apremilast is more promising than treatment with biologics, although a higher incidence of poor response and low adherence to treatment were described [17][18][19][20], which determines the relevance of searching for predictors of apremilast effectiveness.…”

“…Safety profile of apremilast is more promising than treatment with biologics, although a higher incidence of poor response and low adherence to treatment were described [17][18][19][20], which determines the relevance of searching for predictors of apremilast effectiveness. Whereas the search for such predictors was made by pharmacogenetics [17,21] and proteomic [16] research, studies of gene expression patterns associated with the clinical outcomes of apremilast treatment were not conducted at all or were rather limited. The goal of our study was to assess changes in the expression level of cytokine genes in the skin of patients with moderate-to-severe or severe psoriasis with different outcomes of apremilast treatment…”