1
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Panda G, Sahoo JP, Mohanty P, Swain TR. Apremilast or Methotrexate: The Arrows in the Quiver for Psoriasis. Cureus 2023; 15:e38802. [PMID: 37303409 PMCID: PMC10250565 DOI: 10.7759/cureus.38802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In the Indian subcontinent, psoriasis cases have skyrocketed in the last decade. Dry and hot weather aggrandizes the annual incidences. Nowadays, dermatologists harness methotrexate and apremilast to manage chronic plaque psoriasis. There needs to be more comparative studies on these drugs. The primary objective was change in Psoriasis Area and Severity Index (PASI) at six months from the baseline. Change in Dermatology Life Quality Index (DLQI) at six months from the baseline and incidences of adverse events served as the secondary objectives. METHODS This randomized, open-label, 24-week study was executed in Srirama Chandra Bhanja (SCB) Medical College, Cuttack, India, from June 2021 to October 2022. The participants were randomized in a 1:1 ratio to receive tablets of either methotrexate 10-15mg weekly once or apremilast 10-30mg twice daily. Efficacy and safety analyses were performed at baseline, eight, 16, and 24 weeks. We used R software (version 4.1.1; R Foundation for Statistical Computing, Vienna, Austria) for data analysis. RESULTS Seventy (82.3%) of 85 enrolled participants completed the study. The mean age of the study population was 41.08±5.17 years. Twenty-two (31.4%) of them were females. The median change in PASI from baseline was -37.25 (-39.00 to -34.25) for apremilast and -34.75 (-37.75 to -31.75) for methotrexate (p=0.006). The median change in DLQI from baseline was -19.50 (-22.00 to -17.00) for apremilast and -21.00 (-25.50 to -17.50) for methotrexate (p=0.079). No serious adverse events were noticed. CONCLUSION Apremilast was more effective than methotrexate in psoriasis treatment. The statistically significant difference was found only in PASI scores.
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Affiliation(s)
- Gautam Panda
- Pharmacology, Sriram Chandra Bhanja Medical College and Hospital, Bhubaneswar, IND
| | | | - Prasenjeet Mohanty
- Dermatology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Trupti R Swain
- Pharmacology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack, IND
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2
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Haller C, Cozzio A, von Kempis J, Rubbert-Roth A. Successful Treatment of Rituximab-Associated Palmoplantar Pustulosis With Apremilast in a Patient With Seropositive Rheumatoid Arthritis. J Clin Rheumatol 2021; 27:e289-e290. [PMID: 32453211 PMCID: PMC8460074 DOI: 10.1097/rhu.0000000000001415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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3
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Marovt M, Marko PB. Apremilast monotherapy for palmoplantar pustulosis: Report of three cases. SAGE Open Med Case Rep 2021; 9:2050313X211034926. [PMID: 34394938 PMCID: PMC8361521 DOI: 10.1177/2050313x211034926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Palmoplantar pustulosis or palmoplantar pustular psoriasis is chronic skin conditions, characterised by eruptions of sterile pustules on an erythematosquamous background. High-quality data on the treatment of palmoplantar pustulosis are limited, and none is accepted as being effective in general. Apremilast is a small molecule inhibitor of phosphodiesterase 4 approved for the treatment of plaque psoriasis and psoriatic arthritis. We report three cases of palmoplantar pustulosis treated with apremilast monotherapy. Our three cases, as well as previous reports, demonstrate the potential for apremilast to be beneficial for a subset of patients with palmoplantar pustulosis or palmoplantar pustular psoriasis.
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Affiliation(s)
- Maruška Marovt
- Department of Dermatovenerology, University Medical Centre Maribor, Maribor, Slovenia
| | - Pij B Marko
- Department of Dermatovenerology, University Medical Centre Maribor, Maribor, Slovenia
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4
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Rajagopalan M, Dogra S, Saraswat A, Varma S, Banodkar P. The Use of Apremilast in Psoriasis: An Indian Perspective on Real-World Scenarios. Psoriasis (Auckl) 2021; 11:109-122. [PMID: 34430450 PMCID: PMC8375310 DOI: 10.2147/ptt.s320810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/20/2021] [Indexed: 12/27/2022] Open
Abstract
Apremilast, an oral phosphodiesterase-4 inhibitor, is approved for use in the management of psoriasis and psoriatic arthritis. Although its efficacy and safety have been well established in clinical studies, in real-world settings, different practice scenarios have been reported. This review paper serves to evaluate clinical real-world scenarios and aspects of treatment for which the information in the literature was considered to be lacking or controversial. Following a literature review, a panel of five dermatologists with expertise in psoriasis considered five scenarios; namely, the positioning of apremilast in psoriasis, its use in difficult-to-treat areas, special conditions and populations, safety, dose titration and dose in maintenance therapy. These were then assessed with psoriasis experts in India using a web-based questionnaire. A total of 28 questions were discussed regarding these scenarios. According to the responses, apremilast is effective in stable mild to moderate psoriasis as monotherapy and in severe psoriasis in combination. Also, a positive response was received with regard to its effectiveness in difficult locations such as the scalp, palms and soles. To reduce adverse effects, prolonged titration therapy over 4 weeks is required and lower doses can be prescribed to maintain remission. Apremilast therapy should be continued for a minimum of 8 weeks once initiated to achieve the desired results, and the total duration of therapy should be about 24 weeks for better efficacy. It is also effective in many other cases, such as obese patients, patients with hepatitis B or C and HIV, or patients on polypharmacy. It was also reported that apremilast requires less prescreening and monitoring than other conventional and biologic systemic therapies. Overall, apremilast is an attractive option for the individualized treatment of psoriasis owing to its favorable safety profile, its ease of oral administration without the need for screening or ongoing laboratory monitoring, and its positive impact on symptoms and lesions in difficult-to-treat areas.
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Affiliation(s)
- Murlidhar Rajagopalan
- Department of Dermatology, Apollo Hospitals, Chennai, Tamilnadu, India
- Correspondence: Murlidhar Rajagopalan Dermatology, Apollo Hospital, No 21, Greams Lane, Off Greams Road, Chennai, 600006, Tamil Nadu, IndiaTel +91 9840045500 Email
| | - Sunil Dogra
- Department of Dermatology, Venereology & Leprology, PGIMER, Chandigarh, India
| | - Abir Saraswat
- Indushree Skin Clinic, Lucknow, Uttar Pradesh, India
| | - Sachin Varma
- Skinvita Clinic Kolkata, Department of Dermatology, Apollo Hospital, Kolkata, West Bengal, India
| | - Pravin Banodkar
- Skin Crest Clinic, Mumbai, Department of Dermatology, Saifee Hospital, Breach Candy Hospital, and St. Elizabeth’s Hospital, Mumbai, Maharashtra, India
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5
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Wilsmann-Theis D, Kromer C, Gerdes S, Linker C, Magnolo N, Sabat R, Reich K, Mössner R. A multicentre open-label study of apremilast in palmoplantar pustulosis (APLANTUS). J Eur Acad Dermatol Venereol 2021; 35:2045-2050. [PMID: 34077577 DOI: 10.1111/jdv.17441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a chronic skin disease with painful erythematous scaly or crusty lesions and pustules on the palms and soles. Apremilast is a phosphodiesterase 4 inhibitor that has proven effective in the therapy of psoriasis, psoriatic arthritis and in oral ulcers associated with Behcet's disease. OBJECTIVE To explore the efficacy of apremilast in PPP. METHODS APLANTUS was a phase 2 single-arm multicentre study of apremilast in 21 subjects with moderate-to-severe PPP. Primary endpoint was the per cent change of the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at week 20 compared to baseline. RESULTS 20 weeks of oral treatment with apremilast in patients with moderate-to-severe PPP resulted in a significant decrease of the PPPASI with a median reduction of 57.1% (p < 0.001), and 61.9% of patients achieved at least a 50% improvement of the PPPASI relative to baseline. The total number of pustules per patient decreased significantly relative to baseline with 76.2% of patients achieving at least a 50% reduction in total pustules count at week 20. Improvement of PPP was also apparent in a significant decrease of the dermatologic life quality index (DLQI). The median DLQI score dropped from 8.5 at baseline to 2.0 at week 20 (p = 0.030). Apremilast was generally well tolerated, and no serious adverse events occurred. CONCLUSIONS Patients with PPP treated with apremilast showed benefit both in objective and subjective disease parameters. Apremilast should be investigated further in this difficult-to-treat skin condition. EudraCT number: 2016-005122-11.
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Affiliation(s)
- D Wilsmann-Theis
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - C Kromer
- Department of Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - S Gerdes
- Center for Inflammatory Skin Diseases, Department of Dermatology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - C Linker
- TFS Clinic, TFS Trial Form Support GmbH, Hamburg, Germany
| | - N Magnolo
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - R Sabat
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Mössner
- Department of Dermatology, University Medical Center Göttingen, Göttingen, Germany
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6
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[Apremilast in the treatment of palmoplantar pustulosis : A case series]. Hautarzt 2021; 72:252-256. [PMID: 32876701 PMCID: PMC7935730 DOI: 10.1007/s00105-020-04676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This is a case series of 8 patients with palmoplantar pustulosis. These patients were treated with the phosphodiesterase‑4 inhibitor apremilast at our psoriasis outpatient clinic at the dermatological department of the University Hospital Innsbruck and we compared and documented the clinical response using an Investigator's Global Assessment (IGA) score over several months. This disease is characterized by its strong negative impact on the quality of life in affected patients, and by its resistance to therapy and its high relapse rate. Therapy options are relatively rare or off label. Apremilast is a safe and effective therapeutic approach in palmoplantar pustulosis.
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7
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Kt S, Thakur V, Narang T, Dogra S, Handa S. Apremilast in treatment of palmoplantar pustulosis - a case series. Int J Dermatol 2021; 60:e247-e248. [PMID: 33475149 DOI: 10.1111/ijd.15398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Soufila Kt
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Thakur
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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8
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Kato N, Takama H, Ando Y, Yanagishita T, Ohshima Y, Ohashi W, Akiyama M, Watanabe D. Immediate response to apremilast in patients with palmoplantar pustulosis: a retrospective pilot study. Int J Dermatol 2021; 60:570-578. [PMID: 33454961 PMCID: PMC8248100 DOI: 10.1111/ijd.15382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 01/17/2023]
Abstract
Background Recent case reports have shown the efficacy of apremilast for the treatment of palmoplantar pustulosis (PPP). However, no study has statistically analyzed the clinical efficacy of oral apremilast in patients with PPP. Objectives To evaluate the effectiveness of apremilast, a phosphodiesterase 4 inhibitor, for PPP. Materials and Methods Among 13 patients who were diagnosed with PPP, 10 patients with PPP with either palmoplantar pustules (>1 mm diameter) or sternoclavicular joint pain were retrospectively analyzed. Results Palmoplantar Pustulosis Area and Severity Index (mean ± SD: baseline, 13.4 ± 9.5 vs. after treatment, 5.1 ± 5.6; P = 0.013) and the number of pustules measuring > 1 mm in diameter (3.9 ± 3.9 vs. 1.3 ± 1.9; P = 0.029) significantly improved in 2 (±1) weeks. Moreover, the Dermatology Life Quality Index (9.7 ± 7.0 vs. 3.3 ± 3.6; P = 0.009) and palmoplantar itching (visual analog scale [VAS] score) (5.6 ± 3.5 vs. 2.1 ± 2.2; P = 0.026) significantly improved in 2 weeks, whereas VAS scores of palmoplantar pain (4.8 ± 4.4 vs. 1.1 ± 2.4; P = 0.081) and sternoclavicular joint pain (3.2 ± 3.8 vs. 2.0 ± 2.6; P = 0.194) did not significantly improve. Diarrhea was observed in 60.0% of our patients. Conclusion Our study demonstrated that apremilast can effectively treat cutaneous manifestations and arthralgia in Japanese patients with PPP who had apparent pustules and/or clavicular‐sternocostal arthralgia. Owing to the retrospective design of the study and a small sample size, placebo‐controlled clinical trials with a larger number of patients are warranted to confirm the efficacy of apremilast for treatment of PPP.
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Affiliation(s)
- Noriko Kato
- Department of Dermatology, Aichi Medical University, Aichi, Japan
| | - Hiroyuki Takama
- Department of Dermatology, Aichi Medical University, Aichi, Japan.,Department of Dermatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoriko Ando
- Department of Dermatology, Aichi Medical University, Aichi, Japan
| | | | - Yuichiro Ohshima
- Department of Dermatology, Aichi Medical University, Aichi, Japan
| | - Wataru Ohashi
- Clinical Research Center, Aichi Medical University, Aichi, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Daisuke Watanabe
- Department of Dermatology, Aichi Medical University, Aichi, Japan
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9
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Abstract
Therapeutic management of pustular psoriasis remains a challenge despite the rapid advance in psoriasis research and the development of drugs, especially biologics. Treatment guidelines have been established for pustular psoriasis, but no controlled studies are present for juvenile pustular psoriasis (JPP). Search of the literature reveals that current evidence of JPP treatment is limited to case reports and case series. Among the conventional drugs for JPP, oral retinoid is the most commonly used, yet concerns for growth disturbance exist. Cyclosporine and methotrexate have also been administered as first-line treatment. Etanercept is the first biological agent approved for juvenile plaque psoriasis, followed by adalimumab. However, infliximab is usually recommended for JPP because of the rapidity of onset, despite not being approved for use in pediatric psoriasis patients. More recently, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab have been approved for adult pustular psoriasis in selected countries. Controlled studies are needed to prove the efficacy and long-term safety of the therapeutic treatments currently used for JPP.
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Affiliation(s)
- Yi-Wei Huang
- Department of Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, No. 7 Chung San South Road, Taipei, Taiwan.
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10
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Misiak-Galazka M, Zozula J, Rudnicka L. Palmoplantar Pustulosis: Recent Advances in Etiopathogenesis and Emerging Treatments. Am J Clin Dermatol 2020; 21:355-370. [PMID: 32008176 PMCID: PMC7275027 DOI: 10.1007/s40257-020-00503-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Palmoplantar pustulosis (PPP) is a chronic, recurrent skin disease belonging to the spectrum of psoriasis. It is characterized by an eruption of sterile pustules on the palms and soles. Recent studies in PPP have focused on genetic differences between pustular phenotypes and the role of the innate immunological system and the microbiome in the etiopathogenesis of the disease. Mutations in IL36RN (a major predisposing factor for generalized pustular psoriasis) were found in selected patients with PPP and were associated with earlier disease onset. Studies have shown that the interleukin (IL)-17 and IL-36 pathways might be involved in the pathogenesis of PPP. A microbiome has been demonstrated in the vesicopustules of PPP, and an abundance of Staphylococcus appears to be increased by smoking. Improved understanding of the underlying etiopathogenesis of PPP has led to advances in treatment options, and targeted therapies for PPP have been evaluated or are under evaluation against more than 12 molecules in ongoing clinical trials. These targets include CXCR2 (IL-8 receptor type B), granulocyte colony-stimulating factor receptor, IL-1 receptor, IL-8, IL-12, IL-23, IL-17A, IL-17 receptor, IL-36 receptor, phosphodiesterase-4, and tumor necrosis factor-α.
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Affiliation(s)
| | - Joanna Zozula
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland.
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11
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Abstract
INTRODUCTION Palmoplantar pustulosis, or pustulosis palmaris et plantaris (PPP), is a chronic, recurrent inflammatory skin disease that is sometimes unresponsive to conventional therapy. The anti-interleukin 23 antibody guselkumab is effective for treating PPP. AREAS COVERED This review details the current understanding of PPP and discusses why guselkumab may be effective. Guselkumab is only approved for the treatment of PPP in Japan. In the United States, Canada, the European Union, and several other countries, it is approved for the treatment of moderate-to-severe plaque psoriasis, but not for PPP. Furthermore, guselkumab was approved only 1 year ago; its efficacy will be proven only by phase 2 and 3 clinical trials. EXPERT OPINION The first double-blinded randomized placebo-controlled trial (RCT) of guselkumab for PPP has been completed. The drug was effective, and guselkumab could be used as a new agent for PPP treatment, in addition to several conventional therapeutics. However, several issues remain. For example, there is no mouse model of PPP, so careful observation of human PPP patients and establishment of a good experimental PPP model are essential.
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Affiliation(s)
- Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine , Ehime, Japan
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12
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Husson B, Barbe C, Hegazy S, Seneschal J, Aubin F, Mahé E, Jullien D, Sbidian E, D'Incan M, Conrad C, Brenaut E, Girard C, Richard M, Bachelez H, Viguier M. Efficacy and safety of
TNF
blockers and of ustekinumab in palmoplantar pustulosis and in acrodermatitis continua of Hallopeau. J Eur Acad Dermatol Venereol 2020; 34:2330-2338. [DOI: 10.1111/jdv.16265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/21/2020] [Indexed: 12/12/2022]
Affiliation(s)
- B. Husson
- Dermatology Department Hôpital Robert‐Debré Reims France
| | - C. Barbe
- Clinical Research Unit Hôpital Robert‐Debré Reims France
| | - S. Hegazy
- Dermatology Department Hôpital Larrey Toulouse France
| | - J. Seneschal
- Dermatology Department National Reference Center for Rare Skin Diseases Hôpital Saint‐André Bordeaux France
| | - F. Aubin
- Dermatology Department Centre Hospitalo‐Universitaire (CHU) Besançon France
| | - E. Mahé
- Dermatology Department Centre Hospitalier (CH) Argenteuil France
| | - D. Jullien
- Clinical Immunology Department CH Lyon‐Sud Lyon France
| | - E. Sbidian
- Dermatology Department Hôpital Henri‐Mondor Créteil France
| | - M. D'Incan
- Dermatology Department CHU Estaing Clermont‐Ferrand France
| | - C. Conrad
- Dermatology Department Lausanne University Hospital CHUV Lausanne Switzerland
| | | | - C. Girard
- Dermatology Department CHU Lapeyronie Montpellier France
| | - M.A. Richard
- Dermatology Department CEReSS‐EA 3279 Research Center in Health Services and Quality of Life Aix Marseille University Universitary Hospital Timone Assistance Publique Hôpitaux de Marseille Marseille France
| | - H. Bachelez
- Université de Paris Paris France
- Dermatology Department Assistance Publique‐Hôpitaux de Paris Hôpital Saint‐Louis Paris France
- Laboratory of Genetics of Skin Diseases INSERM UMR1163 Institut Imagine Necker Hospital Paris France
| | - M. Viguier
- Dermatology Department Hôpital Robert‐Debré Reims France
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13
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Carrascosa de Lome R, Conde Montero E, de la Cueva Dobao P. Refractory palmoplantar pustulosis succesfully treated with apremilast. Dermatol Ther 2020; 33:e13230. [PMID: 31981290 DOI: 10.1111/dth.13230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 11/27/2022]
Abstract
Palmoplantar pustulosis is a chronic inflammatory disease which characterized by a eruption of sterile pustules on the palms and soles. Apremilast is an oral phosphodiesterase-4 inhibitor which is approved for the treatment of chronic plaque psoriasis and psoriatic arthritis. However, no clinical trial has been performed to confirm the efficacy of apremilast for palmoplantar pustulosis yet. Moreover, there are very few cases of this disease treated with apremilast. Herein, we describe a case of a refractory palmoplantar pustulosis succesfully treated with apremilast.
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Affiliation(s)
| | - Elena Conde Montero
- Dermatology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
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14
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Maloney NJ, Zhao J, Tegtmeyer K, Lee EY, Cheng K. Off-label studies on apremilast in dermatology: a review. J DERMATOL TREAT 2019; 31:131-140. [PMID: 30935262 DOI: 10.1080/09546634.2019.1589641] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose: Apremilast is a phosphodiesterase-4 inhibitor FDA approved for psoriatic arthritis and moderate to severe plaque psoriasis. In recent years, multiple studies have suggested other potential uses for apremilast in dermatology. A summary of these various studies will be a valuable aid to dermatologists considering apremilast for an alternative indication.Materials and methods: The PubMed/MEDLINE and ClinicalTrials.gov databases were queried with the term 'apremilast,' with results manually screened to identify published data on off-label uses of apremilast. The article was structured by the quality of evidence available.Results: Apremilast use in dermatology beyond plaque psoriasis and psoriatic arthritis is frequently described in the literature, with a mixture of positive and negative results. Randomized controlled data is available for Behçet's disease, hidradenitis suppurativa, nail/scalp/palmoplantar psoriasis, alopecia areata, and atopic dermatitis.Conclusion: The relatively safe adverse effect profile of apremilast and its broad immunomodulatory characteristics may make it a promising option in the future for patients with difficult to treat diseases in dermatology, refractory to first line therapies, but further studies will be necessary to clarify its role.
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Affiliation(s)
- Nolan J Maloney
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeffrey Zhao
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kyle Tegtmeyer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ernest Y Lee
- David Geffen School of Medicine at UCLA, UCLA-Caltech Medical Scientist Training Program, Los Angeles, CA, USA.,Department of Bioengineering, UCLA, Los Angeles, CA, USA
| | - Kyle Cheng
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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15
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Calleja Algarra A, Aragón Miguel R, Velasco Tamariz V, Prieto Barrios M, Andrés Lencina JJ, Vico Alonso C, Ortiz Romero PL, Rivera Díaz R. Apremilast as a new treatment option for Acrodermatitis continua of Hallopeau. Australas J Dermatol 2019; 60:e237-e238. [PMID: 30623424 DOI: 10.1111/ajd.12990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alba Calleja Algarra
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Institute I + 12, Madrid, Spain.,Complutense University, Madrid, Spain
| | - Raquel Aragón Miguel
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Institute I + 12, Madrid, Spain.,Complutense University, Madrid, Spain
| | - Virginia Velasco Tamariz
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Institute I + 12, Madrid, Spain.,Complutense University, Madrid, Spain
| | - Marta Prieto Barrios
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Institute I + 12, Madrid, Spain.,Complutense University, Madrid, Spain
| | - Juan José Andrés Lencina
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Institute I + 12, Madrid, Spain.,Complutense University, Madrid, Spain
| | - Cristina Vico Alonso
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Institute I + 12, Madrid, Spain.,Complutense University, Madrid, Spain
| | - Pablo L Ortiz Romero
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Institute I + 12, Madrid, Spain.,Complutense University, Madrid, Spain
| | - Raquel Rivera Díaz
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Institute I + 12, Madrid, Spain.,Complutense University, Madrid, Spain
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Afra TP, Razmi TM, Dogra S. Apremilast in Psoriasis and Beyond: Big Hopes on a Small Molecule. Indian Dermatol Online J 2019; 10:1-12. [PMID: 30775293 PMCID: PMC6362739 DOI: 10.4103/idoj.idoj_437_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Apremilast, an orally administered small molecule inhibitor of phosphodiesterase 4 (PDE4), has been licensed by the US Food and Drug Administration for the management of active psoriatic arthritis (March 21, 2014) and moderate to severe plaque psoriasis (September 23, 2014). It has got approval from Drug Controller General of India for marketing in India in 2017. The drug has drawn much attention from the practising dermatologists for its commendable safety profile and prescription convenience. Introduced initially as an orally administered small molecule in psoriasis patients, the drug has now been used in various other indications as evident by the recent surge in literature for its off-label uses. Being a relatively new drug in the treatment armamentarium of psoriasis and other inflammatory dermatoses; in this review, we will discuss various practical aspects of prescribing oral apremilast, based on the current and emerging literature.
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Affiliation(s)
- T. P. Afra
- Department of Dermatology, IQRAA International Hospital and Research Centre, Calicut, Kerala, India
| | - T Muhammed Razmi
- Department of Dermatology, IQRAA International Hospital and Research Centre, Calicut, Kerala, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Eto A, Nakao M, Furue M. Three cases of palmoplantar pustulosis successfully treated with apremilast. J Dermatol 2018; 46:e29-e30. [PMID: 29905386 DOI: 10.1111/1346-8138.14516] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ayaka Eto
- Department of Dermatology, Steel Memorial Yawata Hospital, Fukuoka, Japan.,Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayoshi Nakao
- Department of Dermatology, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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18
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Kivelevitch D, Frieder J, Watson I, Paek SY, Menter MA. Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas. Expert Opin Pharmacother 2018; 19:561-575. [PMID: 29565192 DOI: 10.1080/14656566.2018.1448788] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite great therapeutic advancements in psoriasis, four notable difficult-to-treat areas including the scalp, nails, intertriginous (including genitals), and palmoplantar regions, pose a challenge to both physicians and patients. Localized disease of these specific body regions inflicts a significant burden on patients' quality of life and requires an adequate selection of treatments. AREAS COVERED This manuscript discusses appropriate therapies and important treatment considerations for these difficult-to-treat areas based on the available clinical data from the literature. EXPERT OPINION Clinical trials assessing therapies for the difficult-to-treat areas have been inadequate. With the first biological clinical trial for genital psoriasis pending publication, it is with hope that other biological agents will be evaluated for region-specific psoriasis. A greater understanding of the genetic and immunologic aspects of regional psoriasis, as well as identification of unique biomarkers, will further guide management decisions. For example, the recent discovery of the IL-36 receptor gene for generalized pustular psoriasis may prove valuable for other forms of psoriasis. Ultimately, identification of the most beneficial treatments for each psoriasis subtype and difficult-to-treat area will provide patients with maximal quality of life.
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Affiliation(s)
- Dario Kivelevitch
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Jillian Frieder
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Ian Watson
- b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - So Yeon Paek
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA.,b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - M Alan Menter
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
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Abstract
Psoriasis is a chronic immune-mediated disease associated with several co-morbidities and negative impacts on a patient's quality of life. Despite the advances in biologic therapy, there are still unmet needs in the treatment of psoriasis, as current treatments are limited in terms of long-term efficacy, tolerability, safety, route of administration, and cost. Apremilast is an oral, small-molecule phosphodiesterase 4 inhibitor that works intracellularly by blocking the degradation of cyclic adenosine 3',5'-monophosphate, resulting in increased intracellular cyclic adenosine 3',5'-monophosphate levels in phosphodiesterase 4-expressing cells. This inhibition results in the reduced expression of proinflammatory mediators, and an increased expression of anti-inflammatory mediators, providing apremilast with an anti-inflammatory rather than immunosuppressive mode of action. Apremilast offers a novel therapeutic option for patients with psoriasis and psoriatic arthritis and may fulfill some of the unmet needs in patients with psoriasis. Potential advantages of apremilast include moderate activity for both psoriasis and psoriatic arthritis and efficacy in difficult-to-treat forms of psoriasis, a good safety profile, no need of laboratory prescreening or ongoing monitoring for laboratory parameters, owing to the absence of organ toxicity, a potentially advantageous weight loss effect, and a convenient oral administration and dosing. Cost effectiveness and health economics considerations will be decisive in determining the ultimate place of apremilast in the therapeutic armamentarium for psoriasis.
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Affiliation(s)
- Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Edifício das Consultas Externas, Ex. CICAP, Rua D. Manuel II, s/n, Porto, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Medical School, Universitat Autònoma de Barcelona, Barcelona, Spain
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