Psoriasis: An Effective Oral Treatment
- The drug is called apremilast under the brand name Otezla
- It is indicated in patients with moderate-to-severe plaque psoriasis
- Studied since 2004 in clinical trials in over 3500 patients
Is it effective ?
- In a randomized-control trial 1257 with moderate-to-severe psoriasis and evaluated after 16 weeks (after a week of progressively increasing dosage)
- The most reliable way of measuring psoriasis is the PASI score, which takes into account the redness (erythema), scaling (desquamation), thickness as well as the extent.
- PASI 75 (a 75% improvement of the initial PASI score) was observed in one third of patients created with apremilast (it was compared with a 5% rate in the non-treated group). Itch was markedly improved already significantly from the second week.
- On another positive note, promising results were observed in psoriasis localized on the nails ans scalp.
Is it safe ?
- the most frequent reported adverse event is diarrhea and nausea in around 15% of cases at the beginning of the treatment which is transient.
- depression was observed in 12 treated patients (1.3%) (vs 0.4% in the placebo group)
- suicidal behavior was similar in both groups (1)
It can cause weight loss
- A 5-10% reduction in weight was observed in 12% (96) (vs 5% (19) in the placebo group)
- A higher than 10% reduction in weight loss was observed in 2% (16) (vs 1% (3) in the placebo group)
- The medication has not been studied in pregnant women
- In case of severe renal failure (clearance less than 30ml/min), dosage should be reduced to 1 tab (30mg) a day
- Otezla can interact with rifampicin, which might cause a reduction of its effectiveness. Therefore use of other inducers such as carbamazepine, phenytoin and phenobarbital is not recommended.
Dr Christophe HSU – dermatologist. Geneva, Switzerland
Source of information: published as prescribed drug informtion. JAAD January 2015