The positioning of apremilast in the treatment algorithm for psoriatic arthritis (PsA) is a matter of debate. A recent study by a group of researchers from Spain has concluded that the structured opinion of the experts complies with the existing literature evidence contributing to the framing of consensual guidelines for the use of apremilast in PsA.
The study by Alonso et al. was aimed at gathering the scientific evidence and the experience of experts on the clinical management of PsA with apremilast in Spain. The researchers constituted an expert committee to collect the evidence on the use of apremilast in 5 different clinical scenarios. Subsequently, an expert panel of 17 rheumatologists discussed these scenarios and anonymously answered a questionnaire with 50 questions and 156 items.
The expert panel has reached consensus on 93 of 156 terms following 2 voting rounds. The corresponding degree of consensus reached and areas explored are given below: 53% in the area of efficacy in peripheral PsA, 60% in efficacy in enthesitis and dactylitis, 50% in efficacy in PsA with skin involvement, 67% in implications of safety in the use of apremilast, and 57% in management of comorbidities in patients with PsA.
The research team has corroborated the efficacy, safety, and tolerability profile of the drug, there by recommending it as a new therapeutic option for patients with psoriatic arthritis, especially in those with comorbidities, malignancies and/or infections. The expert committee has also agreed that non-requirement of pharmacological monitoring is one of the major advantages of apremilast over biologics.
References: Torre Alonso JC, Almodóvar González R, Montilla Morales C, et al. Expert recommendations for the use of apremilast in psoriatic arthritis [published online ahead of print, 2022 May 7]. Reumatol Clin (Engl Ed). 2022;S2173-5743(22)00092-2.