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Current Rheumatology Reviews


ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Combination Therapy of Apremilast and Biologic Agent as a Safe Option of Psoriatic Arthritis and Psoriasis

Author(s): Samy Metyas*, Christopher Tomassian, Ramy Messiah, Tina Gettas, Christina Chen and Anne Quismorio

Volume 15, Issue 3, 2019

Page: [234 - 237] Pages: 4

DOI: 10.2174/1573397115666181130094455

Price: $65


Introduction: Psoriasis is a chronic immune-medicated inflammatory condition that affects 2-3% of the population, which can lead to psoriatic arthritis. There are multiple regimens for the treatment of psoriasis including disease- modifying anti rheumatic drugs (DMARDS) and biologic agent, phototherapy and apremilast. While monotherapy with biologic agents is effective for many patients with psoriasis some patients are not satisfied by the outcome and require combination therapy. No data exist on the safety of apremilast as a component of combination therapy with biological therapies.

Objective: The aim of the study was to determine the safety of apremilast in combination of biologic therapies in the treatment of plaque psoriasis and psoriatic arthritis.

Methods: This was retrospective study, open label study carried out at a single community Rheumatology center. Twenty-two patients diagnosed with plaque psoriasis and psoriatic arthritis according to American college of Rheumatology criteria-participated. Apremilast was added to their current biologic agent. Patients were permitted to their current biologic treatment.

Results: Out of 22 patients, six patients developed side effects, none of which caused discontinuation of therapy. Out of the six patients who developed side effects, two patients developed nausea and two patients developed diarrhea. One patient developed weight loss and one patient developed abdominal pain.

Conclusion: Apremilast can be safely combined with all biologic agents in patients with plaque psoriasis or psoriatic arthritis not responding adequately to biologics alone.

Keywords: Psoriasis, psoriatic arthritis, combination therapy, apremilast, biologic, DMARDS.

Langley RGB, Krueger GG, Griffiths CEM. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis 2005; 64(Suppl. 2): ii18-23.
[] [PMID: 15708928]
Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol 2017; 31(2): 205-12.
[] [PMID: 27573025]
Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol 2013; 133(2): 377-85.
[] [PMID: 23014338]
Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008; 58(5): 826-50.
[] [PMID: 18423260]
Moll JMH, Wright V. Psoriatic arthritis Seminars in arthritis and rheumatism 1973; 3(1) WB Saunders
Liu Jung-Tai, et al. Psoriatic arthritis: epidemiology, diagnosis, and treatment. World journal of orthopedics 2014; 537.
Coates LC, Kavanaugh A, Mease PJ, et al. Group for research and assessment of psoriasis and psoriatic arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheumatol 2016; 68(5): 1060-71.
[] [PMID: 26749174]
Kavanaugh A, Mease PJ, Gomez-Reino JJ, et al. Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann Rheum Dis 2014; 73(6): 1020-6.
[] [PMID: 24595547]
Edwards Christopher J, et al. Long-term 52-week results of palace 3, a phase 3, randomized, controlled trial of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with psoriatic arthritis and current skin involvement. Rheumatology 2014; 53(Suppl. 1): i138-9.
Cutolo M, Myerson GE, Fleischmann RM, et al. A phase III, randomized, controlled trial of apremilast in patients with psoriatic arthritis: results of the PALACE 2 trial. J Rheumatol 2016; 43(9): 1724-34.
[] [PMID: 27422893]
Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: Results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1). J Am Acad Dermatol 2015; 73(1): 37-49.
[] [PMID: 26089047]
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; 173(6): 1387-99.
[] [PMID: 26357944]
Tillett W, Costa L, Jadon D, et al. The ClASsification for Psoriatic ARthritis (CASPAR) criteria--a retrospective feasibility, sensitivity, and specificity study. J Rheumatol 2012; 39(1): 154-6.
[] [PMID: 22089469]
AbuHilal M, Walsh S, Shear N. Mohn’D., Scott Walsh, and Neil Shear. “Use of apremilast in combination with other therapies for treatment of chronic plaque psoriasis: a retrospective study. J Cutan Med Surg 2016; 20(4): 313-6.
[] [PMID: 26848145]
Schafer P. Apremilast mechanism of action and application to psoriasis and psoriatic arthritis. Biochem Pharmacol 2012; 83(12): 1583-90.
[] [PMID: 22257911]
Zerilli Tina, Ocheretyaner Eric. Apremilast (Otezla): a new oral treatment for adults with psoriasis and psoriatic arthritis. Pharmacy and Therapeutics 2015; 40: 495.
AbuHilal M, Walsh S, Shear N. Mohn’D, Scott Walsh, and Neil Shear. “Use of apremilast in combination with other therapies for treatment of chronic plaque psoriasis: a retrospective study. J Cutan Med Surg 2016; 20(4): 313-6.
[] [PMID: 26848145]
Danesh Melissa J, et al. Apremilast and adalimumab: a novel combination therapy for recalcitrant psoriasis. Dermatology online journal 2015; 21.
Mease PJ, Armstrong AW. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs 2014; 74(4): 423-41.
[] [PMID: 24566842]
Germano Valentina, et al. Infection risk in rheumatoid arthritis and spondyloarthropathy patients under treatment with DMARDs, corticosteroids and TNF-α antagonists. J Transl Med 2014; 12: 77.

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