Lower Real-World Drug Survival for Apremilast in Psoriasis vs Clinical Trials

Patients appear to face more challenges with the treatment of psoriasis in real-world settings than in randomized controlled trials, suggesting low drug survival of the phosphodiesterase 4 inhibitor apremilast in real-world practice, according to study results published in the Journal of the American Academy of Dermatology.¹

Patients with psoriasis who were treated with apremilast at any time between Match 1, 2016, and April 24, 2018, were evaluated. Forty-eight patients total were enrolled in the study. Overall, 35.41% (17 of 48) of the participants continued receiving apremilast at the conclusion of the study, with treatment duration ranging from 130 to 627 days. In the current study, the remaining 64.58% (31 of 48) of patients who discontinued therapy did so after an average of 169 days and a median 144 days of treatment. None of the patients were lost to follow-up. The mean drug survival duration was 313 days (95% CI, 247-378 days), and the median drug survival was 200 days.

With respect to treatment discontinuation rates, the results of the current study show a higher discontinuation rate (64.58%) compared with discontinuation rates in the study by Lee and associates (50.6%),² the study by Fougerousse and coworkers (44%),³ and the study by Cattan and colleagues (47%).⁴

Although Lee and associates demonstrated similar persistence rates among individuals who had tried other systemic therapies and those who had not,² the striking differences between the 2 studies might be because in the current study, only 4 patients were treatment-naive for systemic therapies, with 31 patients having received ≥2 prior systemic therapies and 11 of them ≥1 biologic agent. This suggests that having received prior treatment might have an effect on drug survival rates. According to a retrospective study by Ighani and coworkers, this implies that patients have more challenging cases of psoriasis in real-world practice than in randomized controlled trials.⁵

The investigators concluded that the results of this study and the comparator studies cited strongly support the need for future studies of apremilast to better understand the appropriate usage of this agent for the treatment of psoriasis.

References

1. Santos-Juanes J, Velasco L, Munguía-Calzada P, Lozano A, Gómez-Díez S. Low drug survival of apremilast for psoriasis in a real-word-setting [published online June 11, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.05.1254
2. Lee EB, Amin M, Wu JJ. Drug survival of apremilast for psoriasis in a real-world setting [published online March 24, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.03.028
3. Fougerousse AC, Parier J, Bastien M, et al. Expérience de l’aprémilast en « vraie vie ». Ann Dermatol Venereol. 2017;144:S105.
4. Cattan R, Bachelerie M, Biard B, Manard S, D’Incan M. L’Otezla® dans la « vraie vie » : attention aux « idées noires » et aux hépatites. Ann Dermatol Venereol. 2017;144:S215.
5. Ighani A. Georgakopoulos JR, Shear NH, Walsh S, Yeung J. Short-term reasons for withdrawal and adverse events associated with apremilast therapy for psoriasis in real-world practice compared with in clinical trials: a multicenter retrospective study. J Am Acad Dermatol. 2018;78(4):801-803.