How to scientifically deal with adverse reactions when Apremilast (Otelor) occurs

Apremilast (trade name: Otelac) is an oral phosphodiesterase 4 (PDE4) inhibitor. It is used to treat moderate to severe psoriasis and psoriatic arthritis. It can reduce skin and joint symptoms by regulating inflammatory signaling pathways. Although its tolerability is generally good, varying degrees of adverse reactions may still occur during clinical use, including gastrointestinal symptoms, neuropsychiatric symptoms, weight loss and mild abnormalities in laboratory indicators. To scientifically deal with these adverse reactions, we need to take reasonable intervention measures based on the severity of symptoms, time of occurrence, and individual patient conditions to ensure efficacy while reducing discomfort.

First of all, the most common adverse reactions are gastrointestinal symptoms, including diarrhea, nausea, vomiting and indigestion. Usually occurs during the first few weeks of medication and gradually decreases with continued use. Coping strategies include dietary adjustments, such as eating smaller meals more frequently, avoiding high-fat, spicy foods, and ensuring adequate fluids. If the symptoms are mild, they can be relieved by taking the medication in divided doses or extending the dose escalation time. For patients with severe diarrhea or persistent nausea, they should communicate with their doctor in a timely manner to evaluate whether the drug needs to be temporarily discontinued or the dose adjusted, and other potential causes, such as infection or the effects of accompanying drugs, should be investigated.

Secondly, weight loss and loss of appetite are also phenomena that occur in some patients. The mechanism of Apremilast may affect energy metabolism and appetite control. Therefore, during treatment, patients should pay attention to regular weight monitoring and make up for insufficient intake through a balanced diet and an increase in high-nutrient foods. If there is significant weight loss (such as more than 5–10% body weight), the doctor may evaluate the risks and benefits of continuing to take the medication, and adjust the dose or temporarily discontinue the medication if necessary. During long-term use, regular nutritional assessment can help patients maintain a stable weight while reducing the risk of treatment interruption.

Third, changes in neuropsychiatric symptoms and laboratory indicators also require attention. A small number of patients may experience mild headache, insomnia, anxiety or depression. Patients and their families need to closely observe their mood and sleep conditions and report to their doctors in a timely manner. For patients with a history of mental illness, the risks should be fully assessed before use. In terms of laboratory indicators, Apremilast can cause mild abnormalities in liver function or renal function indicators. Therefore, during long-term treatment, blood routine, liver and kidney functions, and electrolytes should be regularly monitored in order to detect abnormalities early and take intervention measures, such as adjusting the dose or extending the reexamination interval.

In addition, scientific response to adverse reactions also includes following the principles of individualized dose adjustment and progressive medication. Apremilast The starting dose is usually lower than the maintenance dose and gradually increased over several days, which can significantly reduce the incidence of gastrointestinal discomfort. If moderate adverse reactions occur during the maintenance dose period, you should consider temporarily reducing the dose or re-increasing it in stages under the guidance of a doctor, rather than stopping the medication or increasing or decreasing the dose on your own, so as not to affect the efficacy. Educating patients to reasonably expect drug reactions, recording symptom changes and medication time can also help doctors manage adverse events more accurately and improve tolerance and treatment compliance.

Generally speaking, Apremilast has mostly controllable and reversible adverse reactions. The principles of scientific treatment are early identification, symptom intervention, individualized adjustment and regular monitoring. Through diet and lifestyle management, staged dose escalation, symptomatic treatment, and regular laboratory monitoring, most patients can successfully complete long-term treatment with improvement in skin and joint symptoms. Maintaining close communication with doctors and promptly reporting any abnormal reactions are key strategies to ensure both efficacy and safety, so that Apremilast can fully exert its anti-inflammatory and improve quality of life clinically.

Reference materials:https://www.cancer.gov/about-cancer