Background: Apremilast (APR) is a phosphodiesterase 4 Inhibitor. APR has been demonstrated to be an effective and safe therapy in the treatment of active psoriatic arthritis (PsA) and psoriasis in patients who were intolerant of or unresponsive to synthetic Disease-modifying Antirheumatic Drugs (DMARDs).
Objectives: To assess the effectiveness and survival rates of APR in a cohort of patients diagnosed with PsA and psoriasis with arthritis in real clinical practice.
Methods: An open, longitudinal, prospective, descriptive study. A total of 80 patients diagnosed with PsA or psoriasis with arthritis were included. All patients received the starting dose of oral APR as per the Summary of Product Characteristics and a maintenance dose of 30mg every 12 hours. The following variables were collected: age, gender, years of evolution, prior treatment with DMARDs, swollen and tender joint counts (SJC, TJC), C-Reactive Protein (CRP), and presence of dactylitis, enthesitis and cutaneous psoriasis. Treatment response was evaluated in all patients at 6, 12 and 18 months follow-ups. Efficacy in patients with PsA was evaluated using the Disease Activity in Psoriatic Arthritis (DAPSA)-based criteria: low activity (DAPSA 5-14) and clinical remission (DAPSA 0-4). To assess the level of enthesitis, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) index was used. Efficacy in patients with psoriasis was evaluated using the Psoriasis Area and Severity Index (PASI)-based criteria: PASI-75 (improvement ≥ 75% of the baseline PASI). Kaplan-Meier method was used for survival analysis.
Results: Of the 80 patients included in our cohort: 42 patients were diagnosed with PsA and 38 with psoriasis. 57,1% of patients with PsA and 63,2% of patients with psoriasis were men with a mean age of 48.2 ± 11.1 and 48.2 ± 14.8 and mean duration of disease 3.5 ± 1.4 and 3.2 ± 2.6 years respectively. Most of the patients with PsA (93%) had cutaneous disease and enthesitis and dactylitis were present in 45% and 31% respectively. 95% of patients with PsA had received prior treatment with Metotrexate. At 6, 12 and 18 months, there was a statistically significant decrease from baseline in TJC, SJC and DAPSA scores. The decrease in the MASES index and the levels of PCR were not statistically significant (Table 2). According to DAPSA, at 18 months follow-ups, clinical remission rate was 77.8%, and low activity rate was 22.2%. 55% of patients with psoriasis reached PASI-75 at 18 months. APR survival rates at 6, 12 and 18 months was 67,85 %, 56,45% and 50,2 % in patients with ApS and 74,8%, 70,4% and 65,1 % in patients wiyh psoriasis.
Conclusion: APR is an effective drug for the treatment of psoriatic arthritis and psoriasis, reaching statistical significance according to DAPSA, and with a high survival rate after 18 months of treatment.
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Mease Philip J, DD Gladman, A Ogdi et al. Treatment to Target in Psoriatic Arthritis with Apremilast: Probability of Achieving Targets and Comprehensive Control of Disease Manifestations. Arthritis Care & Research, 2020.
Disclosure of Interests: None declared
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