Apremilast Combination Therapy Helps Maintain Therapeutic Response in Psoriasis

Plaque psoriasis on the hand
Plaque psoriasis on the hand
The use of apremilast in combination with biologic or systemic agents has been recommended for disease control in those patients with challenging psoriasis that cannot be controlled with the use of a single agent alone.

Treatment with apremilast monotherapy and apremilast combination therapy is associated with favorable 52-week maintenance of therapeutic response in approximately two-thirds of patients with plaque psoriasis, with minimal mild to moderate adverse events (AEs) reported, according to the results of a multicenter, retrospective study conducted at 2 tertiary academic hospitals in Toronto, Canada, and published in the Journal of the American Academy of Dermatology.

The investigators sought to evaluate the long-term (52-week) efficacy and safety of apremilast monotherapy compared with apremilast combination therapy in clinical practice in patients with psoriasis. Patients ≥18 years of age who had been diagnosed with plaque psoriasis and were being treated with apremilast were eligible for participation in the study.

Those who achieved a 75% reduction in the Psoriasis Area and Severity Index-75 or a Physician Global Assessment score of 0/1 at week 16 of treatment were included in the study. Efficacy (ie, maintenance of Psoriasis Area and Severity Index-75 or Physician Global Assessment 0/1) and safety (AEs reported) were assessed between weeks 16 and 52 of treatment. Participants were permitted to use topical agents throughout the treatment period. Those in the combination therapy group included those who were using concurrent biologic or systemic agents along with apremilast.

A total of 48 participants were included in the study — 21 in the monotherapy group and 27 in the combination therapy group. In significantly more patients in the combination therapy group, therapy with a prior biologic or conventional systemic agent had failed compared with in those in the monotherapy group (85.2% vs 57.1%, respectively; P =.001).

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Comparable proportions of patients in the monotherapy and combination therapy groups maintained therapeutic response at week 52 (monotherapy: 66.7%; combination therapy: 63.0%; P =.787). Moreover, similar rates of AEs were reported in both groups (monotherapy: 14.3%; combination therapy: 22.2%; P =.484); headache was the most common AE. Among the most frequently used combination therapy agents were methotrexate (18.5%), etanercept (18.5%), and ustekinumab (18.5%).

The investigators concluded that based on the findings from this study, physicians should consider using apremilast in combination therapy with biologic or systemic agents for the long-term maintenance of therapeutic response among patients with difficult-to-treat psoriasis that is not controlled with the use of one agent alone.


Ighani A, Georgakopoulos JR, Shear NH, Walsh S, Yeung J. Maintenance of therapeutic response over one year using apremilast combination therapy compared to monotherapy for the treatment of plaque psoriasis: a multicenter, retrospective study [published online May 3, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.04.043