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Real‐world use of apremilast for patients with psoriasis in Japan
Author(s) -
Kishimoto Megumi,
Komine Mayumi,
Hioki Tomoyuki,
Kamiya Koji,
Sugai Junichi,
Ohtsuki Mamitaro
Publication year - 2018
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/1346-8138.14617
Subject(s) - apremilast , medicine , psoriasis , adverse effect , nausea , diarrhea , vomiting , psoriatic arthritis , rash , methotrexate , dermatology , psoriasis area and severity index , gastroenterology
Abstract Apremilast is a novel oral phosphodiesterase 4 inhibitor effective for psoriasis. It regulates the production of pro‐inflammatory mediators. Apremilast was approved in December 2016 in Japan; however, its efficacy and safety in a real‐world setting among Japanese patients have not been reported. We report on 44 patients treated with apremilast between March and October 2017. The median treatment duration was 25 weeks (range, 2–33). Thirty‐five patients (79.5%) continued the drug for at least 23 weeks, and five (11.4%) achieved a Psoriasis Area and Severity Index 100 response within 12 weeks. Nine patients discontinued the drug within 24 weeks mainly due to insufficient efficacy ( n = 3) and adverse events ( n = 4). Seven patients continued their previous systemic therapies such as cyclosporin ( n = 1), methotrexate ( n = 1), etretinate + methotrexate ( n = 1) and biologics ( n = 4) combined with apremilast. Of these patients, 55.9% had at least one adverse event although no severe adverse events. The most common adverse event was diarrhea (31.8%), followed by nausea (25.0%), headache (13.6%), abdominal discomfort (6.8%) and vomiting (6.8%). The proportion of diarrhea in our patients was higher than those of previous clinical trials. Among 10 patients with psoriatic arthritis, apremilast did not improve joint pain in nine (90%). To investigate the relationship between treatment efficacy and plaque size, we defined a small plaque as an individual rash diameter of 1 inch or less. The efficacy of apremilast was greater in patients with small plaques than in patients with large plaques.