Year Book of Dermatology – 2018 Psoriasis Jayakar Thomas
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Apremilast in Psoriasis–A Prospective Real-world StudyARTICLE 1

Vujic I, Herman R. Sanlorenzo M, et al. Apremilast in psoriasis - A prospective real-world study.
J Eur Acad Dermatol Venereol. 2018;32(2):254-9.


Apremilast is an oral phosphodiesterase-4 inhibitor approved for the treatment of psoriasis. Various phase III trials have proved it to be safe and efficacious. This article is a prospective real-world study on the use and safety of apremilast in psoriasis and also to calculate the drug survival. About 48 patients were given apremilast and were evaluated every 4 weeks. The parameters evaluated were weight, height, age, joint involvement, PASI score, adverse effects and previous treatments. PASI 50, PASI 75 and PASI 90 were used to assess the efficacy of treatment.
This article is a prospective real-world study of the effect of apremilast in psoriasis patient. Apremilast is an oral phosphodiesterase-4 inhibitor used for psoriasis and psoriatic arthritis treatment.
A total of 48 patients were included in the study and the study was conducted over a period of 1 year 9 months.
The parameters studied were the drug survival (time from initiation to discontinuation of therapy) and the efficacy which was analyzed by means of PASI 50, PASI 75 and PASI 90 (Improvement in the psoriasis area severity index by 50, 75 and 90 points respectively).
The patients were followed up every 4 weeks and the parameters which were recorded in the proforma included the weight, height, age, family history, treatment history, presence of joint involvement, smoking status, PASI scores and the adverse effects if any (onset and duration).
The median drug survival was 12.5 weeks which can also be used as a measure of efficacy of the drug and compliance. PASI 50, PASI 75 and PASI 90 were achieved by eight, nine, and three patients respectively.
There was a negative impact of obesity on the PASI 50 response. Obese individuals have shown a less response to treatment in other studies as well and they also present with more severe disease.
Only 31 patients had adverse effects, the most common of which was diarrhea followed by headache and joint pain but none severe enough to stop treatment.
The trials done for apremilast in were ESTEEM and PALACE which showed significant greater results than in this real-world trial.
More long-term studies with a larger number of subjects are needed on apremilast to confirm these findings. Wide spread availability of apremilast with cost-effective rates in developing countries compared to developed countries will help in performing these studies.2