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