Short course of Apremilast and phototherapy combination not sufficient for psoriasis management

A combination of Phototherapy and apremilast was not effective for the management of Psoriasis Vulgaris as per a recent study that was published in The Journal of Dermatology. 

Apremilast is an oral phosphodiesterase-4 inhibitor. Phototherapy and apremilast are commonly used in the management of moderate to severe Psoriasis Vulgaris. But the current evidence on the efficacy and safety of their combination is not sufficient. Hence researchers conducted a multicenter, randomized controlled study to compare the efficacy and safety between phototherapy as monotherapy and a combination of phototherapy and apremilast in patients with Psoriasis Vulgaris.

All the patients with moderate to severe Psoriasis Vulgaris were randomized to two groups of combination therapy with 29 participants and monotherapy with 13 participants. All patients underwent an 8-week phototherapy regimen comprising irradiation with narrowband UV-B. The patients in the combination group were also administered 10 mg to 60 mg of oral apremilast. Psoriasis Area and Severity Index (PASI) score from baseline to week 8 were the tools used to estimate the percentage of improvement. The percentage of patients who achieved ≥75% improvement in the changes in body surface area (BSA) and scores of EuroQol 5-dimensions 5-level, Dermatology Life Quality Index, and visual analog scale for pruritis from baseline to 4 and 8 weeks and any adverse events were also evaluated.

Findings:

• The combination group had significantly lower PASI scores at 4 and 8 weeks and more patients achieved a PASI score improvement of ≥75% at 8 weeks when compared with the monotherapy group. 
• A significant decrease in BSA at 8 weeks was seen in both groups.
• There was no significant difference observed between the two groups, although the combination group tended toward a greater reduction in BSA. 
• The intergroup differences in the changes at the three-time points were not significant.
• Adverse events were more frequent in the combination group than in the monotherapy group.

This study shows that an 8-week combined apremilast and phototherapy regimen may not be adequate in patients for improvements in their subjective assessment of psoriasis, and longer treatment periods may be necessary. 

Further reading: Morita A, Yamaguchi Y, Tateishi C, Ikumi K, Yamamoto A, Nishihara H, Hayashi D, Watanabe Y, Watanabe Y, Maruyama A, Masuda K, Tsuruta D, Katoh N. Efficacy and safety of apremilast and phototherapy versus phototherapy only in psoriasis Vulgaris. J Dermatol. 2022 Sep 24. doi: 10.1111/1346-8138.16566. Epub ahead of print. PMID: 36151864.