Addition of Apremilast to Biologic Therapy Is Successful for Treating Psoriasis in Biologic Fatigue

The combination of apremilast and a biologic is a safe, useful treatment choice for managing patients with psoriasis who are experiencing biologic fatigue.

The combination of apremilast with biologics is safe and associated with reductions in the mean Psoriasis Area and Severity Index (PASI) score in patients with psoriasis who have recently shown biologic fatigue, according to study results published in the Journal of Dermatology.

The study was a retrospective analysis of efficacy and safety results of a combination psoriasis treatment regimen consisting of apremilast and biologics (n=14). Patients included in the analysis were initially treated with ≥1 biologic, but after the efficacy of the biologic(s) declined, apremilast was added to the existing treatment program. Biologics included infliximab, adalimumab, secukinumab, ixekizumab, and ustekinumab.

Changes in the PASI score, as well as achievement of 75% and 50% reductions in PASI Score (PASI-75 and PASI-50, respectively), were assessed at weeks 0, 12, and 24 after the apremilast addition.

A total of 11 patients achieved a 90% improvement in PASI score after biologic therapy, with the lowest PASI scores ranging from 0 to 3.8 (mean, 1.3±0.3). Prior to biologic treatment, PASI scores in the overall cohort ranged from 5.9 to 39.0 (mean, 19.5±2.7). The mean PASI score before the addition of apremilast to biologic therapy was 3.2±0.4. The addition of apremilast to the existing biologic treatment protocol decreased the mean PASI score to 1.6±0.3 at 24-week follow-up. Approximately 50% of patients had achieved PASI-50, whereas only 29% achieved PASI-75 at 24 weeks.

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There were 4 patients who developed diarrhea during the 24 weeks and 1 patient reported both diarrhea and nausea. In 2 patients, weight loss >5% of body weight occurred. Adverse events were not severe enough to cause any patient to discontinue the combination treatment.

Study limitations were the small number of patients, the inclusion of only patients with biologic fatigue, and its retrospective nature.

Based on their findings, the investigators concluded “that apremilast could be safely combined with a biologic in psoriatic patients who are not responding adequately to a biologic alone.”

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Takamura S, Sugai S, Taguchi R, Teraki Y. Combination therapy of apremilast and biologics in patients with psoriasis showing biologic fatigue [published online December 22, 2019]. J Dermatol. doi:10.1111/1346-8138.15193