Apremilast for the treatment of psoriatic arthritis

Abstract

Psoriatic arthritis occurs in about one-third of patients with psoriasis, and is a severely disabling, progressive inflammatory spondyloarthropathy typically treated with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, TNF-α inhibitors and ustekinumab. These medications moderately improve the arthritis, dactylitis, and enthesitis that characterize psoriatic arthritis, however, they are associated with serious long-term adverse effects, issues with safety and tolerability, and high cost. Moreover, many patients do not respond or have resistant or recurrent manifestations to these agents. Apremilast is an orally available phosphodiesterase type 4 inhibitor that may block the pathogenic inflammatory Th17 and Th1 pathways upstream of current biologics, which target extracellular molecules of the immunological response.

Keywords::

• apremilast
• biologic
• phosphodiesterase inhibitor
• psoriasis
• psoriatic arthritis

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Psoriatic arthritis (PsA) therapy is currently centered on non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs and biologics that target the key proinflammatory cytokines of the Th1 and Th17 immune pathways.

• Current systemic therapies for PsA can be compromised by loss of efficacy over time, adverse events, safety and tolerability issues, required subcutaneous or intravenous administration and high cost.

• Apremilast, a novel, orally available inhibitor of phosphodiesterase type 4, may represent an effective, well-tolerated, safe and easily administered treatment for PsA.

• Apremilast’s use will depend upon its cost as well as evidence of long-term safety and efficacy.