Apremilast: An Orally-Active Small Molecule 
                     HOW APREMILAST TABLETS IS USEFUL IN PSORIATIC 
 ARTHRITIS
Otezla 30 mg (apremilast tablet) is used to treat patients with psoriatic arthritis and  
moderate to severe plaque psoriasis who are candidates for the treatment of the skin with  
an ultraviolet light source.
Apremilast 30 mg blocks the production of an enzyme called phosphodiesterase 4 (PDE4)  
and leads to a reduction in inflammation. Apremilast is typically prescribed to patients with  
failure of one or more disease-modifying drugs (DMARDs) but are not suitable for biologic  
therapies.
 Apremilast is an oral first-in-class phosphodiesterase 4 inhibitor that was approved  
by the FDA for the treatment of adults with active psoriatic arthritis and adults with  
moderate to severe plaque psoriasis.
 The recommended daily dose is 30 mg twice daily and initial doses should be titrated 
 over the course of about a week to reduce gastrointestinal adverse reactions.
 Apremilast was shown to be moderately effective in clinical trials at reducing  
symptoms of psoriatic arthritis including tender and swollen joints and physical  
functioning (ACR20) in patients who have failed previous treatments. Concomitant  
treatment with methotrexate or other conventional systemic disease-modifying  
antirheumatic drugs (DMARDs) was allowed. Results from 4 clinical trials showed  
NNTs ranging from 4-10 with 30 mg twice daily dosing.
 Apremilast tablet was shown to be moderately effective in clinical trials at improving  
symptoms and quality of life for patients with plaque psoriasis. Results from two  
clinical trials showed statistically significant improvements in 75% improvement in  
Psoriasis Area and Severity Index (PASI-75) with 20 mg twice daily and 30 mg twice  
daily dosing.
 Depression may develop or worsen during therapy; educate patients and use caution  
in patients with a history of depression or suicidality. The most common adverse  
reactions reported were diarrhea, headache, nausea, and upper respiratory tract  
infection.
There is moderate quality evidence consistently showing apremilast to be a safe and  
effective medication in the treatment of adults with moderate to severe psoriatic arthritis or  
plaque psoriasis. For psoriatic arthritis, the clinical trials showed improvement in clinical  
symptoms such as tender or swollen joints, however, they did not evaluate improvements in  
or slowed progression of radiographic damage to
affected joints.
The major benefit of otezla 30 mg are convenient administration and lack of monitoring.  
Apremilast appears to be safe in short-term studies. These advantages need to be weighed
against cost, lack of long-term safety data, and lack of radiographic evaluation. Direct  
comparisons with active therapies, long-term studies beyond 1 year and radiographic  
outcome measures are needed to determine its role in therapy.
Cost of Apremilast: Availability of low-cost apremilast tablet or otezla 30mg sounds good. A  
respective patient can purchase this medication from only a registered and certified  
pharmaceutical company.
Source: http://the-indian-pharma.over-blog.com/how-apremilast-tablets-is-useful-in-  
psoriatic-arthritis.html