Apremilast improves severity, quality of life in mild to moderate psoriasis
Overall psoriasis severity and scalp psoriasis, as well as itch and quality of life, were improved in patients who used apremilast, according to a phase 3 study.
“Mild to moderate psoriasis may present substantial quality-of-life (QOL) impairment despite patients having less overall skin involvement than those with more severe disease. ... Due to limited body surface area involvement, these patients may be classified as having mild or moderate disease,” Linda Stein Gold, MD, and colleagues wrote. “Topical treatments have demonstrated efficacy and tolerability for mild to moderate psoriasis and are the initial treatment for patients with mild to moderate psoriasis. However, for some patients topical treatments may not achieve sufficient disease control or may be impractical to apply.”
The double-blind, placebo-controlled ADVANCE trial included 595 patients who were randomly assigned 1:1 to receive apremilast or placebo.
At week 16, static Physician Global Assessment (sPGA) score of 0 or 1 (clear or almost clear) with a 2-point or greater reduction from baseline was reported in 21.6% of those in the treatment group and 4.1% of those in the placebo group (P < .0001).
Secondary endpoints, including a body surface area (BSA)-75 response and BSA of 3% or less, were also statistically significant for the apremilast treatment group. BSA-75 was reported in 33% of the apremilast group compared with 7.4% of the placebo group, and BSA of 3% or less was recorded in 61% of the apremilast group and 22.9% of the placebo group (P < .0001 for both).
Whole body itch was reduced by at least 4 points in 43.2% of individuals in the treatment group compared with 18.6% of the placebo group. Forty-four percent of those in the treatment group had scalp PGA of 0 or 1 and a 2-point or greater reduction compared with 16.6% in the placebo group (P < .0001 for both).
Angina pectoris and myocardial ischemia, which are serious treatment-emergent adverse events, were reported in one patient in the apremilast group, whereas serious treatment-emergent adverse events were reported in four patients in the placebo group.
“Apremilast significantly and clinically meaningfully reduced overall psoriasis severity and improved scalp psoriasis, whole body itch and QOL in patients with mild to moderate plaque psoriasis,” the authors wrote.