Background Apremilast is a phosphodiesterase4 inhibitor. Two pivotal trials were carried out comparing apremilast to placebo in plaque psoriasis (PP). At week 16, significantly more patients taking apremilast achieved PASI75 (28.8%–33.1%) in both trials, versus placebo (5.3%–5.8%).
Purpose To assess the adaptation of the PP treatment prescriptions of apremilast under the Hospital Protocol and its economic impact, and to assess the percentage of patients who reached PASI75 at week 16.
Material and methods A descriptive, retrospective study was conducted between March 2016 and October 2017 on apremilast prescriptions. Patients with PP treated with apremilast were included and data were available from medical histories. According to the use protocol (UP) of apremilast, it should be used in patients with PP who have any contraindication to biologic therapies (BT) such as immunosuppression, due to the fact that indirect comparisons suggested that it is less efficient than BT.
Results After designing the UP of apremilast, 32 prescriptions from the Dermatology Department were registered. 34.37% of patients (11/32) met the requirements of use (contraindication of BT). If the compliance of the UP had been 100%, 21 patients would have been treated with etanercept (the first-line BT chosen in our centre). Thus, it would have lead to a cost saving of 19.85% of the cost per patient/year in PP treatment since a year of treatment with etanercept costs €6245.52, whereas with apremilast it is €7794.2. Data concerning initial PASI and PASI at week 16 were available in 56.25% (18/32), in which 27.77% reached PASI75 (5/18). Among 43.75% (14/32) of patients without PASI75 results, 42.85% (6/14) had no data about PASI, 42.85% (6/14) had not already reached week 16 and in 14.28% (2/14) the treatment had been withdrawn because of adverse events (AE). Twenty-five per cent (8/32) of patients did not currently continue with the treatment, 25% (2/8) of them because of AE and 75% (6/8) because of lack of efficacy.
Conclusion The implementation of a consensual UP for new treatments such as apremilast could enhance the rational use of this drug, but further collaboration with the physicians is needed to achieve a better optimisation of the available resources.
No conflict of interest
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