Comparison of efficacy of apremilast versus methotrexate in patients with moderate to severe chronic plaque psoriasis
Keywords:
Efficacy, Apremilast, Methotrexate, Chronic plaque psoriasisAbstract
Objective To compare the efficacy of apremilast versus methotrexate in patients with moderate to severe chronic plaque psoriasis. Methods Comparative Experimental Study, which was conducted in Department of Dermatology, Mayo Hospital Lahore. Total 112 patients enrolled after informed consent and divided into two groups. Group A received apremilast 30mg twice daily from day 6 onwards (titrating the dose in the first five days) and Group B given methotrexate 0.3-0.5mg/kg orally. Efficacy assessed by reduction in PASI score comparing baseline with score at end of 12 weeks. Results Reduction in PASI score from baseline 24.58±5.17 to 9.90±4.18 at the end of 12 weeks (efficacy 47.3%) observed in Group A, while in Group B, PASI score reduced from 25.38±8.41 to 12.94±4.95 (efficacy 21.80%). Adverse effects for both groups were minimal. Conclusion Both apremilast and methotrexate are good treatment options and highly effective in treating chronic plaque psoriasis. However, apremilast showed greater efficacy and reduction in PASI score as compared to methotrexate.References
Parisi R, Symmons DP, Griffiths CE. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013; 133:377–85.
Ding X, Wang T, Shen Y, Wang X, Zhou C, Tian S, et al. Prevalence of psoriasis in China: a population-based study in six cities. Eur J Dermatol. 2012; 22:663-7.
Tribo MJ, Turroja M, Castano-Vinyals G, Bulbena A, Ros E, Gracia-Martinez P, et al. Patients with moderate to severe psoriasis associate with higher risk of depression and anxiety symptoms: results of a multivariate study of 300 Spanish individuals with psoriasis. Acta Derm Venereol. 2019; 99:1-5.
Evers AW, Verhoeven EW, Kraaimaat, FW. How stress gets under the skin: cortisol and stress reactivity in psoriasis. Br J Dermatol. 2018; 163:986–91.
Griffiths C, Barker J, Bleaker T, Chalmers R, Ceamer D. Management of psoriasis and related disorders. Rooks textbook of Dermatology 9TH edition. 2016; 35:22-29.
Gao JC, Wu AG, Contento MN, Maher JM, Cline A. Apremilast in the Treatment of Plaque Psoriasis: Differential Use in Psoriasis. Clin Cosmetic Invest Dermatol. 2022; 15:395-402.
Haider S, Wahid Z, Najam-us-Saher, Riaz F. Efficacy of Methotrexate in patients with plaque type psoriasis. Pak J Med Sci. 2014; 30(5):1050-53.
Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. The Lancet. 2018; 391(10136):2273-84.
Ohtsuki M, Okubo Y, and Komine M. Apremilast, an oral phosphodiesterase 4 inhibitor, in the treatment of Japanese patients with moderate to severe plaque psoriasis: Efficacy, safety and tolerability results from a phase 2b randomized controlled trial. J Dermatol. 2017; 44(8):873–84.
Van Voorhees AS, Gold LS, Lebwohl M, Strober B, Lynde C, Tyring S, et al. Efficacy and safety of apremilast in patients with moderate to severe plaque psoriasis of the scalp: results of a phase 3b, multicenter, randomized, placebo-controlled, double-blind study. J Am Academy Dermatol. 2020; 83(1):96-103.
AbuHilal MD, Walsh S, Shear N. Use of apremilast in combination with other therapies for treatment of chronic plaque psoriasis: a retrospective study. J Cutaneous Med Surg. 2016; 20(4):313-6.
Rosie TN, Khan AL, Khan MS, Yazdi QS, Karim AR. Efficacy and safety of apremilast versus methotrexate in the treatment of chronic plaque psoriasis. J Armed Forces MedColl, Bangladesh. 2020; 16(1):39-41.
Armstrong AW, Betts KA, Sundaram M, Thomason D, Signorovitch JE. Comparative efficacy and incremental cost per responder of methotrexate versus apremilast for methotrexate-naïve patients with psoriasis. J Am Academy Dermatol. 2016; 75(4):740-6.
Thai S, Zhuo J, Zhong Y, Xia Q, Chen X, et al ,Real- world treatment patterns and healthcare costs in patients with psoriasis taking systemic oral or biologic therapies, J. of Dermatol Treat, 2023(Accepted author version posted online: 16 Feb 2023) DOI: 10.1080/ 09546634.2023.2176708
Lomholt G. Psoriasis: Prevalence, Spontaneous Course and Genetics. A Census Study on the Prevalence of Skin Diseases on the Faroe Islands. Copenhagen: GEC Gad. 2013:31–3.
Farber EM, Nall ML. The natural history of psoriasis in 5600 patients. Dermatologica. 2014; 148:1–18.
Nevitt GJ, Hutchinson PE. Psoriasis in the community: prevalence, severity and patients’ beliefs and attitudes towards the disease. Br J Dermatol. 2016; 135:533–7.
Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 2015; 13:450-6.
Gottlieb, AB., Ryan, C., Murase, JE. Clinical considera- tions for the management of psoriasis in women.Int J Women Dermatol. 2019; 5(3):141-50.
M.M. Gawlik, B. Topczewska, D. Kurpas . Quality of life of psoriatic patients – modulatory variables. Fam Med Prim Care Rev 2016; 18(3): 235–40.
M. Augustin, G. Glaeske, M.A.Radtke, Reich K., Christophers E., Schaefer I., et al. Epidemiology and comorbidity of psoriasis in children. Br J Dermatol, 2010; 162:633-6.
R.S. Stern, T. Nijsten, S.R. Feldman, et al.Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. J Investig Dermatol Symp Proc 2004; 9:136-9.
Colombo G., Altomare G., Peris K,, Martini P., Quarta G., Congedo M., et al. Moderate and severe plaque psoriasis: cost-of-illness study in Italy. Ther Clin Risk Manag. 2008 Apr;4(2):559-68.
.Fry L. Psoriasis. Br J Dermatol. 2008; 119(4):445-61.
Roenigk HH Jr, Auerbach R, Maibach HI, and Weinstein GD. Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol. 2018; 19:145-56.
Nickoloff BJ, Mitra RS, Green J, Zheng XG, Shimizu Y, Thompson C, et al. Accessory cell function of keratinocytes for superantigens. Dependence on lymphocyte function-associated antigen-1/ intercellular adhesion molecule-1 interaction. J Immunol. 2013; 150(6):2148-59.
Haustein UF, Rytter M. Methotrexate in psoriasis: 26 years’ experience with low-dose long-term treatment. J Eur Acad Dermatol Venereol. 2000; 14:382–8.
Gottlieb AB, Strober B, Krueger JG. An open-label, single-arm pilot study in patients with severe plaque-type psoriasis treated with an oral anti-inflammatory agent, apremilast. Curr Med Res Opin. 2008; 24:1529-38.
Helmick CG, Lee-Han H, Hirsch SC, Baird TL, Bartlett CL. Prevalence of psoriasis among adults in the U.S.: 2003-2006 and 2009-2010 National Health and Nutrition Examination surveys. Am J Prev Med. 2014; 47(1):37-45.
Paul C, Cather J, Gooderham M, Poulin Y, Mrowietz U, Ferrandiz C, et al. Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate‐to‐severe plaque psoriasis over 52 weeks: a phase III, randomized controlled trial (ESTEEM 2). Br J Dermatol. 2015; 173(6):1387-99.