Clinical efficacy, speed of improvement and safety of apremilast for the treatment of adult Psoriasis during COVID‐19 pandemic

Abstract

Time to improvement is a crucial characteristic for effective treatments of chronic inflammatory conditions, such as psoriasis. Apremilast is a recently approved drug, belonging to the small molecule phosphodiesterase 4 inhibitors, whose optimal safety and efficacy profile is somewhat affected by slow activity rate in clinical trials. Real world case series are suggesting a more consistent improvement, and with this additional personal investigation on 48 patients, we signal that 58% of patients achieved Psoriasis Area and Severity Index (PASI) 50, and 19% PASI 75 improvement in the first 8 weeks of treatment. Results at 16‐week are remarkable, with overall 55% of patients achieving PASI 75, 21% PASI 90 and 14% PASI 100. Only 8 patients (18, 6%) had slightly improved, although satisfied with the regimen, and determined to continue. Noteworthy, our population was rather problematic in terms of comorbidities (86%), and resistance to other treatments, with only 28% naïve to systemics, including biologics. Moreover, the observation period includes the Italian outbreak of COVID‐19 epidemic, and further information on apremilast safety are provided, no one of the patients having stopped treatment. In such a critical period, the apremilast satisfactory speed of therapeutic response in a real‐world setting has further strengthens patient's compliance to remain safely at home, which is the best strategy to limit contagion.

COVID ‐19 patients with psoriasis and psoriatic arthritis on biologic immunosuppressant therapy vs apremilast in North Spain

“…7 Results in realworld settings have further reinforced the safety and efficacy of apremilast on psoriasis patients during the COVID-19 pandemic. 13 In conclusion, apremilast does not seem to particularly increase susceptibility to infection and can be considered a safe alternative for both infected and uninfected COVID-19 patients. IL-17 inhibitors seem to have also a relatively safe profile, while with systemic agents and TNFα inhibitors cautions are advised.…”

“…12 Several studies have reported a good efficacy and an excellent safety profile for apremilast in the treatment of psoriasis and psoriatic arthritis. 12,13 Regarding virus infections, large studies have shown a significant decrease of serious infection rate in apremilast-treated patients. 14 In a prospective safety study on the long-term safety of different medications for psoriasis, authors reported that apremilast patients had a lower risk of infections and infestations.…”

Effect of immunosuppressive drugs in immune‐mediated inflammatory disease during the coronavirus pandemic

“…Indeed many authors reported that none of the patients treated with Apremilast developed COVID-19 related symptoms. 40 We combined the present evidences from this paper with the management suggestion already in place, 41,42 and developed an algorithm for the management of patients treated with DMARDs during this pandemic ( Figure 2). The main limitation of our pooled analysis is the small sample size, possibly not allowing adequate statistical power, even if representing an insightful description of the now available best knowledge about the topic.…”

Experience in managing psoriasis patients receiving targeted therapy during the COVID-19 pandemic

“…В настоящее время мнение экспертов заключается в том, что апремиласт является одним из более безопасных вариантов лечения псориаза средней и тяжелой степени тяжести с учетом его специфического неиммуносупрессивного механизма действия. Недавний опыт лечения больного с COVID-19, который продолжал лечение апремиластом во время двусторонней пневмонии и полностью выздоровел, подтверждает безопасность и совместимость с лечением критически больных пациентов [11][12][13].…”