Product Theater – Let’s Talk About an Option for Your Patients with Challenging Manifestations of Psoriasis
Faculty: Michael Shane Chapman, MD
Dr. Michael Chapman presented the afternoon product theater reviewing Otezla (apremilast). Otezla is indicated for the treatment of adult patients with active psoriatic arthritis and patients with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy. He mentioned we should approach “psoriasis as a systemic condition rather than just a skin disease”. In addition to arthritis, up to 50% of patients with psoriasis will have metabolic disease. Topical monotherapy is not a cure for psoriasis. It is common for patients to become frustrated with the need to continue topical treatment indefinitely which often leads to poor adherence. Dr. Chapman reports systemic options may be more appropriate for patients who present with scalp and nail psoriasis.
Otezla (apremilast) is an inhibitor of phosphodiesterase 4 (PDE4) delivered through an oral medication. For patients who are reluctant to try a systemic medication that requires needles for administration, Otezla may be a good way to introduce systemic therapy. Unlike most systemic treatments, no laboratory work is required prior to initiation of treatment with Otezla. The most common adverse reactions with apremilast are upper respiratory infection, tension headache, headache, nausea, vomiting and diarrhea. For most patients, GI upset is most prevalent within the first few weeks of treatment. Dr. Chapman encouraged close monitoring for dehydration of older individuals with GI upset.
Unlike most systemic treatments, no laboratory work is required prior to initiation of treatment with Otezla.
Additionally, a weight decrease of 5-10% of body weight has been found in up to 12% of patients who are treated with Otezla. Dr. Chapman reports this weight loss is not associated with GI upset. Lastly, Otezla has been associated with an increase in depression and therefore it is important to carefully weigh the risks and benefits in patients with a history of depression, suicidal thoughts or behaviors or in patients who develop symptoms of depression.
Additionally, a weight decrease of 5-10% of body weight has been found in up to 12% of patients who are treated with Otezla.