Patients with diabetes who also have psoriasis or psoriatic arthritis may achieve better results with PDE4 inhibitor apremilast, but patients with psoriasis who receive the therapy tend to achieve improvement in their disease, according to study research published in the Journal of Dermatology.
In this observational study, a total of 113 outpatients with psoriasis and/or psoriatic arthritis (mean age, 64 years; mean disease duration, 10 years) were recruited from a hospital’s dermatology unit in Rome, Italy. Patients were treated with twice-daily apremilast 60 mg per day for 52 weeks.
The Psoriasis Area and Severity Index (PASI) response scale, DAS‐28, and Dermatology Life Quality Index (DLQI) score at weeks 12, 24 and 52 were used to assess efficacy of apremilast. Adverse events (AEs) associated with the treatment were assessed during treatment. During the 52-week period, metabolic markers were compared in patients with diabetes vs patients without diabetes.
The investigators reported a 79.1% PASI reduction from baseline to weeks 24 and 52 in the cohort of apremilast-treated patients with psoriasis and psoriatic arthritis. In addition, there was a 77% reduction in the pain visual analog scale from baseline to weeks 24 and 52. The DLQI reduced by 79% from baseline to weeks 24 and 52. Patients with diabetes had a greater improvement in psoriatic disease compared with the group of patients without diabetes. Patients without diabetes and low-density lipoprotein (LDL) cholesterol less than the median had a better result in metabolic markers with apremilast compared with patients with diabetes. In an analysis that used glucose as a dichotomous variable, statistical significance was demonstrated for patients with diabetes and LDL cholesterol less than the median.
Limitations of the study were the lack of cohort stratification based on diabetic medications and the reliance on blood glucose rather than HbA1c to assess blood sugar control.
The researchers concluded that “apremilast could be used successfully in psoriatic patients affected by cardiometabolic comorbidities, ensuring an improvement in both diseases.”
Mazzilli S, Lanna C, Chiaramonte C, et al. Real life experience of apremilast in psoriasis and arthritis psoriatic patients: preliminary results on metabolic biomarkers [published online April 1, 2020]. J Dermatol. doi: 10.1111/1346-8138.15293