Summer 2018 | Live Blog | Product Theater | Are Your Topical Patients Systemic Ready? An Oral Treatment Option for Moderate to Severe Plaque Psoriasis
The second product theater on day 2 of the SDPA Annual Summer Conference presented by Robert Casquejo, PA-C discussed Otezla as a treatment for adult patients with active psoriatic arthritis and patients with moderate to severe plaque psoriasis who are candidates for phototherapy and systemic therapy.
Otezla is an oral medication that inhibits phosphodiesterase 4 (PDE4). Historically, psoriasis was believed to be a disorder of keratinocytes and with further research, it has been realized that it is largely a systemic disease with a dysregulation of the immune system. Compliance, the need for large quantities and penetration of topical therapies limit their long-term use. For example, penetration of the scalp and nails can be difficult to achieve with topical therapies for psoriasis. When initiating a systemic treatment for psoriasis, safety is a concern for both patients and prescribers.
Mr. Casquejo stated the most common adverse reactions to Otezla are diarrhea, nausea and headache. For those who are vulnerable to problems with diarrhea, nausea and vomiting, these patients may be at an increased risk for these conditions. For the majority of patients, the GI symptoms go away with time. Patients with a history of depression should use caution when initiating treatment with Otezla. Furthermore, the use of strong cytochrome P450 enzyme inducers such as rifampin, phenobarbital, is not recommended because loss of efficacy may occur. For patients with renal impairment, the dosage of Otezla should be decreased.
Trials with Otezla show the average improvement in PASI scores at 16 weeks is 55%. Otezla has shown improvement for difficult to treat areas such as the scalp and nail. Additionally, scores on the dermatology quality of life index have been observed to improve significantly when patients take Otezla for their psoriatic disease. An additional benefit of Otezla is that there is no requirement for routine lab monitoring in patients who take Otezla. Finally, Otezla has revealed close to 50% improvement of tender and swollen joints in patients with psoriatic arthritis.