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Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
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Apremilast in psoriasis - a prospective real-world study.

I Vujic1,2, R Herman1,2, M Sanlorenzo3,4

  • 1Dermatology, The Rudolfstiftung Hospital, Vienna, Austria.

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|September 20, 2017
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Apremilast (a phosphodiesterase-4 inhibitor) shows real-world effectiveness for psoriasis, with about 40% achieving PASI50 or higher. However, obesity may reduce treatment efficacy, and few patients reach PASI90.

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Area of Science:

  • Dermatology
  • Pharmacology
  • Clinical Research

Background:

  • Apremilast is an oral phosphodiesterase-4 inhibitor approved for psoriasis.
  • Real-world data on apremilast efficacy and safety in psoriasis patients are limited.
  • This study addresses the scarcity of real-world evidence for apremilast in psoriasis management.

Purpose of the Study:

  • To characterize patients with psoriasis treated with apremilast in a real-world clinical setting.
  • To evaluate the drug survival rates of apremilast as a measure of efficacy and patient compliance.
  • To identify factors influencing apremilast treatment outcomes in psoriasis.

Main Methods:

  • Retrospective analysis of 48 psoriasis patients treated with apremilast from April 2015 to January 2017.
  • Data collected included patient demographics, psoriasis severity (PASI scores), adverse events, and drug survival.
  • Kaplan-Meier analysis was used to estimate drug survival; efficacy was assessed by PASI50, PASI75, and PASI90 response rates.

Main Results:

  • Median apremilast drug survival was 12.5 weeks. PASI50, PASI75, and PASI90 responses were achieved by 16.7%, 18.8%, and 6.3% of patients, respectively.
  • Patient weight inversely correlated with PASI50 response. Obese patients (BMI > 30) showed significantly lower rates of PASI75 response compared to non-obese patients.
  • Adverse events were reported by 64.6% of patients, most commonly diarrhea (43.8%), headache (14.6%), and joint pain (10.4%).

Conclusions:

  • Apremilast demonstrates safety and effectiveness for treating skin psoriasis in real-world clinical practice.
  • While apremilast can lead to significant lesion improvement (PASI50+), achieving high levels of response (PASI90) is uncommon.
  • Body weight, particularly obesity, may negatively impact the efficacy of apremilast in psoriasis patients.