Background The current treatment for psoriasis depends on the severity of the disease, in mild disease topical therapies alone, and with increasing disease severity in combination with phototherapy and/or traditional systemic therapy (methotrexate, cyclosporine, acitretin) or biologics agents.
Apremilast is a selective inhibitor of phosphodiesterase 4, able to down-regulate the inflammatory associated with psoriasis. An oral option for treating chronic moderate/severe plaque psoriasis (PP) in adults whose disease has not responded to other therapies or are contraindicated/not tolerated.
Purpose To report the hospital cases of moderate/severe PP treated with apremilast, describing patients’ profile and analysing the efficacy and safety of apremilast.
Material and methods A retrospective case series. We reviewed the clinical history of the patients with moderate/severe PP treated with apremilast until August 2018.
To assess the severity of the disease: Psoriasis Area and Severity Index (PASI) or% of body surface area (BSA). Moderate disease: PASI≥10 or 5%–10% of BSA; severe disease: PASI>20 or BSA >10%. Adequate response to treatment: 90%, 75% or 50% reduction (improvement) from baseline in PASI score (PASI90, PASI75 or PASI50) at 16 weeks.
We investigated previous treatments from the beginning of the disease, analysed the efficacy of apremilast collecting the PASI or BSA scores at the beginning, after 16 and 32 weeks, and collected the adverse events during the treatment.
Results Eighteen patients, 83% men, mean age 52 (±12) years. Three patients suffered PP and psoriatic arthritis. Previous treatment: 83% (15) topical therapies and 17% (three) phototherapy. Sixty-seven per cent (12) had received prior systemic therapy with conventional agents and 17% (three) biologic agents. At the start of apremilast: five patients suffered severe disease, nine moderate disease and one without data. Three patients were unmeasurable because of the recent start of apremilast. Sixty per cent (nine) of patients achieved PASI75/PASI90 from baseline at week 16, thirty-three per cent (five) PASI50% and 7% (one) without improvement. Maintenance improvement at week 32 (21% without data): 64%. During treatment six gastrointestinal adverse events, one atrial fibrillation and two cholesterol increased.
Conclusion Almost all patients had received prior systemic therapy with conventional agents and/or biologics. The use of premilast has some advantages including oral administration, being well tolerated and with a safer profile. It will likely be of value to these patients and those who may not be candidates for biologics.
References and/or acknowledgements No conflict of interest.
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