阿普斯特片的功效和副作用

In view of its good efficacy in clinical trials, my country approved Apremilast as an oral small molecule drug to treat moderate to severe plaque psoriasis and joint psoriasis in September 2021. Multiple studies have shown that Apremilast is effective in treating moderate to severe plaque psoriasis in a dose-dependent manner. So, what are the efficacy and side effects of Apremilast tablets?

What does Apremilast tablets do?

Apremilast is a new oral small molecule phosphodiesterase 4 (PDE4) inhibitor that can inhibit PDE4 activity, increase intracellular cyclic adenosine monophosphate levels, further regulate the expression of tumor necrosis factor and other inflammatory cytokines, and ultimately inhibit the inflammatory response.

Clinical data shows that Apremilast can significantly improve psoriasis on nails, scalp, palms and soles (hands and feet), and effectively treat psoriatic arthritis, providing a very valuable treatment option for psoriasis patients.

Apremilast tablets benefits

Spencer et al. analyzed 17 studies, including 5 placebo-controlled randomized clinical trials (RCTs), 1 phase II clinical trial, 2 randomized methotrexate comparative trials, 6 cohort studies, and 3 case series, with a total of 1117 participants. They found that after 16 weeks of treatment, Apremilast achieved a Palmoplantar Pustulosis Physician Global Assessment (PPPGA) of 0/1 (baseline PPPGA ≥ 3), which was better than placebo [1].

In the placebo-controlled RCT, apremilast was superior to placebo in achieving Palmoplantar Pustulosis Severity Index (PPPASI) 50 at week 16 and was equivalent to methotrexate in achieving PPPASI 50.

Studies have shown that Apremilast treatment significantly improved patients' PPPASI, PPPGA and DLQI scores.

Apremilast side effects

1. Psoriatic arthritis: The most common (≥5%) are diarrhea, nausea and headache.

2. Psoriasis: The most common side effects (≥5%) are diarrhea, nausea, upper respiratory tract infection and headache, including tension headache.

Summary

In summary, it can be seen that Apremilast is an oral small molecule PDE-4 inhibitor with significantly higher efficacy than placebo. It is easy to administer and has no cumulative toxicity in specific organs. It is very suitable for patients who require long-term maintenance medication. However, the incidence of adverse reactions of Apremilast is also high, such as diarrhea, nausea, weight loss, etc., which is related to its oral administration method. When taking the drug, you can consider adjusting the dosage time and gradually increasing the dosage in small doses, with the purpose of reducing the patient's gastrointestinal adverse reactions and establishing tolerance.

References

[1] Zhang Ting, Yan Jingru, Chen Peishan, et al. Meta-analysis of the efficacy and safety of Apremilast in the treatment of scalp psoriasis [J]. Chinese Journal of Dermatology and Venereology, 2023, 37(09): 1028-1036. DOI: 10.13735/j.cjdv.1001-7089.202209102.

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