Apremilast: A Review in Psoriasis and Psoriatic Arthritis

Apremilast (Otezla^®) is an orally administered, small molecule inhibitor of phosphodiesterase 4 (PDE4). Apremilast 30 mg twice daily reduced the severity of moderate to severe plaque psoriasis in the phase 3 ESTEEM trials, as well as improving difficult-to-treat nail, scalp and palmoplantar psoriasis. Most patient-reported outcomes, including pruritus and the total Dermatology Life Quality Index, also improved to a significantly greater extent with apremilast than with placebo, with significant improvements in pruritus and skin discomfort/pain visual analogue scale scores seen as early as week 2 with apremilast. Apremilast 30 mg twice daily improved signs and symptoms in both disease-modifying antirheumatic drug (DMARD)-naïve and DMARD-experienced patients with active psoriatic arthritis in the phase 3 PALACE trials. Enthesitis, dactylitis, physical function and fatigue were also improved with apremilast, and its efficacy was sustained for up to 208 weeks. Apremilast had an early onset of efficacy in patients with active psoriatic arthritis, with significantly more apremilast 30 mg twice daily than placebo recipients achieving a ≥20% improvement in modified American College of Rheumatology response criteria at week 2 in the phase 3b ACTIVE trial. Apremilast was generally well tolerated in patients with psoriasis and psoriatic arthritis; no laboratory monitoring is required. In conclusion, orally administered apremilast is an effective, generally well tolerated and convenient option for the treatment of psoriasis and psoriatic arthritis.