Apremilast in psoriasis patients with serious comorbidities: a case series and systematic review of literature

Aikaterini Tsentemeidou; Elena Sotiriou; Nikolaos Sideris; Katerina Bakirtzi; Ilias  Papadimitriou; Aimilios Lallas; Dimitrios Ioannides; Efstratios Vakirlis

doi:10.5826/dpc.1204a179

Apremilast in psoriasis patients with serious comorbidities: a case series and systematic review of literature

Authors

Aikaterini Tsentemeidou First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
Elena Sotiriou First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
Nikolaos Sideris First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
Katerina Bakirtzi First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
Ilias Papadimitriou First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
Aimilios Lallas First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
Dimitrios Ioannides First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
Efstratios Vakirlis First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece

Keywords:

apremilast, comorbidities, medical dermatology, psoriasis, biologics

Abstract

Introduction: Patients with serious comorbidities are traditionally excluded from clinical trials. Apremilast is not contraindicated in active infections, malignancy and serious hepatic or renal impairment, but real-life data is needed to support this recommendation.

Objectives: The aim of this paper is to present our personal as well as literature-sourced real-world evidenced on apremilast use in psoriasis patients with serious baseline comorbidities.

Methods: A case-series and systematic literature review were performed. The psoriasis archives of a tertiary-care hospital, four electronic databases (MEDLINE, ScienceDirect, Cochrane Library, Google scholar) and other sources were searched (2014 – July 2021). Identified records were considered eligible, if they reported on the use of apremilast monotherapy in psoriasis patients with chronic infections, history of malignancy, serious liver, renal, psychiatric, or other disease(s).

Results: At least 841 psoriasis patients with serious baseline diseases received apremilast. Only 3 cases of cancer progression and no infection reactivations or worsening of other diseases were documented. No increased frequency / severity of adverse events or reduced drug efficacy were noted. Main limitations of this study are the exclusion of a few reports due to inappropriately documented data and the fact that at least some patients might have been counted more than once.

Conclusions: Apremilast is a safe and adequately efficacious option for psoriasis that cannot be treated / is challenging to treat with classic systemic agents and/or biologics.

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