Apremilast as a treatment for psoriasis

Abstract

Introduction: Psoriasis is a common skin disorder characterized by chronic inflammatory lesions that are frequently vexing for patients and difficult for physicians to treat. Although multiple therapeutic options are available, all have limitations. Topical preparations have issues with patient adherence, as compared to oral routes of administration. Currently available oral medications, such as methotrexate, possess unfavorable toxicity profiles that limit use. There is a large unmet need for an effective, safe oral treatment for psoriasis. Apremilast is an oral medication that inhibits the activity of multiple inflammatory markers involved in the pathogenesis of psoriasis.

Areas covered: The present review article presents the pharmacokinetic properties of apremilast, as well as available preliminary pre-clinical and clinical trial data, and gives an overview of its safety and efficacy.

Expert opinion: Apremilast has been well tolerated in phase I and II clinical trials. It has favorable safety and toxicity profiles at doses that are also effective for the treatment of plaque psoriasis. Phase III clinical trials are currently underway and will better elucidate appropriate dosing of apremilast and further illuminate its side effect profile. In future studies, a comparison of apremilast to other psoriasis medications administered through different routes would be beneficial, to document whether patient adherence is better with an oral medication. Depending on the price of the agent, efficacy and perhaps most importantly its safety profile, apremilast may fill a key need as a safe, first-line oral treatment for patients with psoriasis.

Keywords::

• cytokines
• PDE 4
• phosphodiesterase type 4
• psoriasis
• TNF-alpha

Acknowledgement

The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. S Feldman has received consulting, speaking and/or grant support from Galderma Laboratories, L.P., GSK/Stiefel, Abbott Labs, Leo, Centocor, Amgen, Astellas, Coria, Anacor, Celgene, and Aventis Pharmaceuticals, has received stock options from Photomedex, and holds stock in www.DrScore.com. B Shutty, M Pellerin, and C West Shave no conflicts of interest to disclose.