Apremilast in psoriasis patients with serious comorbidities: a case series and systematic review of literature

Tsentemeidou, Aikaterini; Sotiriou, Elena; Sideris, Nikolaos; Bakirtzi, K; Papadimitriou, Ilias; Lallas, Aimilios; Ioannides, Dimitrios; Vakirlis, Efstratios

doi:10.5826/dpc.1204a179

Cited by 7 publications

(4 citation statements)

References 56 publications

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“…Bernardini et al observed 28 patients with cancers treated with apremilast for 104 weeks, showing efcacy on both PASI and BSA and without reporting adverse efects [22]. Tsentemeidou et al in a systematic review reported 37 patients with both solid and blood malignancies treated with apremilast with high efcacy and mild side efects [23]. Te same results were reported in a recent French real-world multicenter study [24].…”

Section: Discussionmentioning

confidence: 56%

Apremilast in Patients Difficult to Treat: A Multicentric Real‐Life Long‐Term Experience

Trovato,

Capalbo,

Cartocci

et al. 2023

Dermatologic Therapy

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Psoriasis is an inflammatory disease nowadays considered not only as a cutaneous but also as a systemic disease. Systemic therapy plays a crucial role in the management of psoriasis. Apremilast is an inhibitor of phosphodiesterase-4 (PDE4), indicated in the treatment of moderate-to-severe psoriasis. Here, we report a multicentric case series of patients treated with apremilast with resolution of skin manifestations and maintenance of clinical response for a minimum of 2 years. By inhibiting PDE4, apremilast acts as a ubiquitous intracellular enzyme, whose active form degrades adenosine cyclic intracellular monophosphate (cAMP) into AMP. The increase in cAMP determines a decrease in proinflammatory cytokines such as TNF-a, IL-17, IL-23, and upregulation of IL-10 with an anti-inflammatory action. Considering the growing incidence of comorbidities in the world population and in particular the strict correlation in patients with psoriasis, it is important to identify therapeutic options able to avoid a negative impact on patients with both conditions. The aim of this work is to highlight the utility of this molecule in the long-term management of these patients. Moreover, these case series further underline the high safety profile and manageability of this small molecule.

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Section: Discussionmentioning

confidence: 56%

Apremilast in Patients Difficult to Treat: A Multicentric Real‐Life Long‐Term Experience

Trovato,

Capalbo,

Cartocci

et al. 2023

Dermatologic Therapy

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“…It is labeled for moderate-to-severe forms of psoriasis, psoriasic arthritis, and behçet syndrome. Apremilast is indicated in patients who have severe comorbidities like cancer and important infectious diseases [ 45 ]. Different studies remark on its efficacy as an off-label treatment in other dermatologic disorders like atopic dermatitis [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

New Perspectives in the Management of Chronic Hand Eczema: Lessons from Pathogenesis

Tancredi,

Buononato,

Caccavale

et al. 2023

IJMS

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Chronic hand eczema (CHE) is a common inflammatory skin condition that significantly impacts the quality of life. From work-related disabilities to social embarrassment, pain, and financial costs, the burden on society is substantial. Managing this condition presents challenges such as long-term treatment, poor patient compliance, therapy side effects, and economic feasibility. As a result, significant efforts have been made in this field in recent years. Specifically, the broader understanding of CHE pathogenesis has led to the development of new drugs, both topical and systemic. The aim of this narrative review is to summarize the current available data on hand eczema pathophysiology and explore the resulting developments in drugs for its treatment. A comprehensive search on PubMed and the other main scientific databases was conducted using keywords related to CHE and its pathogenesis. The most relevant pathways targeted by therapies include the JAK-STAT cascade, IL-4, and IL-13 axis, phosphodiesterase 4 enzyme, and chemo-attractant cytokines. In the near future, physicians will have a plethora of therapeutic alternatives. Consequently, they should be well-trained not only in how to use these alternatives but also how to combine these treatments to address the ongoing challenges related to efficacy, tolerability, and safety.

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“…Due to its broad cellular targets and relative tolerability, apremilast has been investigated for its efficacy in chronic inflammatory diseases, including AD and different psoriasis variants ( 15 ). In a recent report documenting the real-life utilization of apremilast in patients diagnosed with both psoriasis and cancer, apremilast demonstrated an improvement in quality of life, while maintaining a favorable safety profile ( 16 , 17 ). Our cases demonstrated the effectiveness of apremilast in achieving remission and maintaining stability without recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…In peripheral blood mononuclear cells, PDE-4 inhibition reduces the production of pro-inflammatory cytokines, including tumor necrosis factor α, IL-12/23, IL-12, and IL-2, while upregulating the anti-inflammatory cytokine IL-10. Due to its broad cellular targets and relative tolerability, apremilast has been investigated for its efficacy in chronic inflammatory diseases, including AD and different psoriasis variants (15). In a recent report documenting the reallife utilization of apremilast in patients diagnosed with both psoriasis and cancer, apremilast demonstrated an improvement in quality of life, while maintaining a favorable safety profile (16,17).…”

Section: Discussionmentioning

confidence: 99%

Case report: Treatment of psoriasiform dermatitis in patients with malignancy

Mao,

Du,

Jia

et al. 2024

Front. Med.

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Psoriasis and atopic dermatitis (AD) are prevalent inflammatory skin disorders, each stemming from diverse factors, and characterized by recurring episodes. In certain complex cases, the clinical and pathological features exhibit overlapping and atypical characteristics, making accurate clinical diagnosis and targeted treatment a challenge. Psoriasiform dermatitis is the term used to describe such cases. Moreover, when patients have a history of malignancy, the situation becomes even more intricate, resulting in limited treatment options. Biologic therapies have transformed the management of immune-mediated inflammatory diseases, including psoriasis and AD. Meanwhile, the safety of biologics in special populations, especially among patients with a history of malignancy, should be underlined. The selective Janus kinase 1 (JAK1) inhibitor abrocitinib has been approved for the treatment of AD and has showed satisfying efficacy and safety in the treatment of psoriasis in clinical trials. Although unreported, JAK1 inhibitors are thought to have the potential to increase the risk of potential tumors. Apremilast, an oral phosphodiesterase (PDE)-4 inhibitor, is approved for moderate to severe plaque psoriasis. It has been investigated for its efficacy in AD, and is not contraindicated in malignancy. This report presents three cases of psoriasiform dermatitis in patients with a history of malignancy, showcasing significant improvement following treatment with systemic glucocorticoid, abrocitinib, or apremilast.

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Apremilast in psoriasis patients with serious comorbidities: a case series and systematic review of literature

Cited by 7 publications

References 56 publications

Apremilast in Patients Difficult to Treat: A Multicentric Real‐Life Long‐Term Experience

Apremilast in Patients Difficult to Treat: A Multicentric Real‐Life Long‐Term Experience

New Perspectives in the Management of Chronic Hand Eczema: Lessons from Pathogenesis

Case report: Treatment of psoriasiform dermatitis in patients with malignancy

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