Comment on “Drug survival of apremilast for psoriasis in a real-world setting”

Abstract

A total of 48 patients were included in the study. At the end of the study period, 35.41% (17/48) of our patients remained on apremilast, with treatment durations ranging 130-627 days compared with 50.6% in the Lee et al study. The patients who stopped taking apremilast (64.58%, 31/48) had treatment failures after an average of 169 days and a median of 144 days. No patient was lost to follow-up. Mean drug survival duration was 313 (95% confidence interval 247-378) days (Fig 1); and median drug survival was 200 days (Fig 2). With the same criteria, the result of this analysis shows a higher discontinuation rate compared with Lee et al's study. Fougerousse et al described a discontinuation of 44% and Cattan et al 47% on the 12th week. 2,3 Although Lee et al showed similar persistence rates among patients who had and had not tried other systemic therapies, we think that the striking differences between their results and ours could be attributed to the fact that in our series only 4 patients were naive for systemic treatments. Hence, having received previous systemic treatments might have affected results. In our study, thirty-one patients had been treated with $2 previous systemic treatments and 11 with $1 biologic treatment. As stated by Ighani et al, this fact implies that patients in real-world practices have more challenging psoriasis than those in randomized controlled trials. 4 Despite the limitations of our study, the results of the 3 studies using patients from world-real practices are concordant and strongly suggest the need to place psoriasis treatment trials at proper sites in future studies.

Drug survival of apremilast in a real‐world setting

“…administration route and favorable safety profile. The drug survival rate of apremilast in our study was similar to those reported previously by Papadavid et al 4 and Ohata et al, 5 and higher than those reported by Lee et al 6 and Santos-Juanes et al 7 The median drug survival period was 453 days, which was longer than those in previous studies (12.5 weeks by Vujic et al 8 and 341 days by Lee et al). 6 Although apremilast is a relatively expensive drug in Japan, there were only two patients who discontinued apremilast due to economic reasons.…”

“…and Ohata et al ., and higher than those reported by Lee et al . and Santos‐Juanes et al . The median drug survival period was 453 days, which was longer than those in previous studies (12.5 weeks by Vujic et al .…”

Persistence of apremilast in moderate‐to‐severe psoriasis: a real‐world analysis of 14 147 apremilast‐ and methotrexate‐naive patients in the French National Health Insurance database

“…A small number of retrospective studies have assessed the efficacy and safety of apremilast in routine practice . However, these results cannot be extrapolated to the entire population of patients with psoriasis, primarily because the sample sizes were small (from 34 to 131 patients).…”

Apremilast in psoriasis and beyond: Big hopes on a small molecule

“…[ 11 ] Safety was not compromised on combining apremilast with other biologic agents in the management of psoriasis and PsA. [ 12 ] A retrospective study by Mayba and Gooderham has reported a better drug survival of apremilast in their patients who were also on other systemic agents (16%),[ 13 ] compared to poor drug survival reported in apremilast monotherapy (49%[ 14 ], 65%[ 15 ]). Hence, combining other systemic agents with apremilast may increase the treatment adherence of patients; however, additional therapeutic benefits in terms of efficacy or tolerability is subject of further research.…”

“…[ 14 ] In another study, a failure rate of 65% was noted after a median duration of 200 days. [ 15 ] Hence, it appears that around half of the patients discontinue apremilast treatment within 6–8 months due to various reasons including lack of efficacy.…”