The Use of Apremilast in Psoriasis: A Delphi Study

Area of Science:

• Dermatology
• Pharmacology
• Clinical Practice

Background:

• Clinical trial data for apremilast is complemented by real-world clinical experience.
• Expert dermatologists reviewed existing literature on apremilast for moderate psoriasis.

Purpose of the Study:

• To assess the efficacy and appropriate use of apremilast in managing moderate psoriasis based on expert consensus.
• To identify specific patient profiles and scenarios where apremilast is most beneficial.

Main Methods:

• A panel of expert dermatologists evaluated 5 clinical scenarios using a Delphi questionnaire.
• Literature review and expert consensus methodology were employed.

Main Results:

• Consensus was achieved on 67% of items assessed, defining therapeutic goals based on clinical response, symptoms, quality of life, and patient satisfaction.
• Apremilast is considered suitable for stable moderate psoriasis, especially when conventional therapies are contraindicated or fail, and before biologic therapy.
• The drug is appropriate for psoriasis in difficult-to-treat areas (scalp, palms, soles) and requires less prescreening and monitoring than other systemic treatments.

Conclusions:

• Apremilast presents a treatment option for patients beyond typical clinical trial participants.
• Limitations include a lack of consensus on defining moderate psoriasis, limited real-world data, and some tolerability concerns.