Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor: A novel treatment option for nurse practitioners treating patients with psoriatic disease.
Melodie Young, Heather L Roebuck
PMID 27869356WHAT IT FOUND
In two placebo-controlled trials, more adults taking oral apremilast achieved a 75% reduction in psoriasis area and severity at 16 weeks than placebo.
Gastrointestinal effects were common early, but depression and weight loss need monitoring.
Key findings
01In ESTEEM 1 and ESTEEM 2, more patients taking apremilast achieved a 75% reduction in psoriasis area and severity score at 16 weeks than placebo (33.1% vs 5.3%; 28.8% vs 5.8%; p < .0001).
02Patients taking apremilast reported a decrease of nearly 50% in itch severity compared with placebo at 16 weeks (31.5 mm vs 7.3 mm decrease in ESTEEM 1; 33.5 mm vs 12.2 mm decrease in ESTEEM 2; p < .0001).
03The most common adverse events were diarrhea, nausea, upper respiratory tract infection, nasopharyngitis, tension headache, and headache; most diarrhea and nausea were mild, occurred early, and resolved with continued dosing, and routine laboratory monitoring is not required.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a new clinical trial, so it summarizes other studies rather than testing apremilast directly. The summarized trials enrolled adults with moderate to severe plaque psoriasis who were candidates for phototherapy or systemic therapy, so the findings do not apply to mild disease or patients not needing those treatments. The review does not compare apremilast with topical therapy, phototherapy, conventional systemic drugs, or biologics. Psychiatric findings are based on low event counts during the 16-week placebo-controlled period, so they are reassuring but not definitive. Long-term extension eligibility is mentioned, but the review does not report four-year extension results.
The easy way to misread this
Do not read the lack of routine laboratory monitoring as meaning apremilast needs no clinical monitoring. The review advises caution in patients with depression or suicidal thoughts, notes weight loss and gastrointestinal events, and recommends dose adjustment in severe renal impairment and avoidance with strong CYP3A4 inducers.