Background and importance Apremilast is a selective inhibitor of type 4 phosphodiesterase taken orally that is indicated in psoriasis and psoriasic arthritis and whose response should be evaluated at 24 weeks of treatment.
Aim and objectives Evaluating the persistence and causes of treatment discontinuation in patients treated with apremilast in our hospital.
Material and methods We made a retrospective study (May 2017 to September 2021) in which all the patients treated with apremilast for at least 24 weeks were included. Data collected: sex, age, diagnosis, start date, last dispensation date and reason of discontinuation treatment if suspension occurred.
Apremilast’s persistence was calculated in weeks by the Kaplain–Meier method. We used SPSS Statistics for analysis, considering a p value <0.05.
Results A total of 32 patients were included (24 with psoriasis and 8 with psoriasic arthritis). 50% of them were men (53.4 ± 11.32) years and the 15.62% were treated previously with biological drugs.
The persistence of apremilast was 52.68 weeks (IC 95% 32.85 to 72.44). 71.8% of the patients discontinued treatment during the study period. Discontinuations were mainly due to adverse events (60.8%) and inefficacy (26.1%). Among the adverse events, most were related to digestive system (71.43%), mainly gastrointestinal discomfort (50%) diarrhoea (35.7%), nausea and vomiting (14.3%), followed by depression (21.4%) and headache (7%).
50% of patients discontinued treatment before completing 24 weeks of treatment due to adverse events (75%) or inefficacy (25%). The remainder of the patients achieved at least 24 weeks of treatment, 3 of them (12.5%) stopped treatment before 52 weeks and the remaining 11 patients (34.7% of the total) were treated for more than 52 weeks. 9 patients (28.1%) are continuing treatment to the end of the study, with 7 of them being treated for more than 52 weeks.
Conclusion and relevance There is a high prevalence of adverse events with apremilast and this is the main cause of treatment discontinuation, follow by inefficacy. However, patients who have good tolerance also achieve a high persistence, thus illustrating the need to select patients who may take benefit of apremilast.
References and/or acknowledgements 1. Paul C, Cather J, Gooderham M, et al. Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate-to-severe plaque psoriasis over 52 weeks: a phase III, randomized controlled trial (ESTEEM 2). Br J Dermatol 2015; doi: https://doi.org/10.1111/bjd.14164
Conflict of interest No conflict of interest