Psoriasis: An Effective Oral Treatment

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Introduction

Is it effective ?

In a randomized-control trial 1257 with moderate-to-severe psoriasis and evaluated after 16 weeks (after a week of progressively increasing dosage)
The most reliable way of measuring psoriasis is the PASI score, which takes into account the redness (erythema), scaling (desquamation), thickness as well as the extent.
PASI 75 (a 75% improvement of the initial PASI score) was observed in one third of patients created with apremilast (it was compared with a 5% rate in the non-treated group). Itch was markedly improved already significantly from the second week.
On another positive note, promising results were observed in psoriasis localized on the nails ans scalp.

Is it safe ?

the most frequent reported adverse event is diarrhea and nausea in around 15% of cases at the beginning of the treatment which is transient.
depression was observed in 12 treated patients (1.3%) (vs 0.4% in the placebo group)
suicidal behavior was similar in both groups (1)

It can cause weight loss

A 5-10% reduction in weight was observed in 12% (96) (vs 5% (19) in the placebo group)
A higher than 10% reduction in weight loss was observed in 2% (16) (vs 1% (3) in the placebo group)

Preacautions

The medication has not been studied in pregnant women
In case of severe renal failure (clearance less than 30ml/min), dosage should be reduced to 1 tab (30mg) a day
Otezla can interact with rifampicin, which might cause a reduction of its effectiveness. Therefore use of other inducers such as carbamazepine, phenytoin and phenobarbital is not recommended.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of information: published as prescribed drug informtion. JAAD January 2015