Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
Servicio de Dermatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España.
Actas Dermosifiliogr (Engl Ed). 2020 Mar;111(2):115-134. doi: 10.1016/j.ad.2019.07.005. Epub 2019 Dec 19.
Experience in the use of apremilast in clinical practice complements the information available from pivotal clinical trials.
Following a review of the literature, a panel of dermatologists with expertise in the management of psoriasis considered 5 scenarios in which the evidence supporting the use of apremilast to treat moderate psoriasis is insufficient or controversial. These scenarios were then assessed using a Delphi questionnaire.
Consensus was reached on 96 (67%) of the 143 items (positive in 85 and negative in 11). The therapeutic goal for apremilast should be based on 4 outcomes: clinical response, symptoms, quality of life, and patient satisfaction. The scenario in which the use of apremilast was considered to have the greatest possibility of success was in patients with stable moderate psoriasis. Most of the clinicians considered apremilast to be an appropriate treatment when conventional therapies fail or are contraindicated, preferably before the prescription of biologic therapy. Consensus was reached that apremilast is an appropriate treatment for psoriasis in difficult locations, such as the scalp or the palms and soles. It was also agreed that apremilast requires less prescreening and monitoring than other conventional and biologic systemic therapies.
Apremilast could be a treatment option for patients with a different profile to that of clinical trial participants. The limitations of this proposal are the absence of consensus on the definition of moderate psoriasis, the lack of real-world evidence on the use of apremilast, and certain aspects related to tolerability.
在临床实践中使用阿普司特的经验补充了来自关键临床试验的可用信息。
在对文献进行回顾后，一组具有银屑病管理专业知识的皮肤科医生考虑了 5 种情况下使用阿普司特治疗中度银屑病的证据不足或存在争议的情况。然后使用德尔菲问卷调查对这些情况进行评估。
在 143 项中的 96 项（阳性 85 项，阴性 11 项）达成了共识。阿普司特的治疗目标应基于 4 个结果：临床反应、症状、生活质量和患者满意度。阿普司特最有可能成功的情况是在稳定的中度银屑病患者中。大多数医生认为，当传统疗法失败或禁忌时，特别是在开生物治疗之前，阿普司特是一种合适的治疗方法。共识是，阿普司特是治疗头皮、手掌和足底等困难部位银屑病的一种合适治疗方法。也一致认为，与其他传统和生物系统性疗法相比，阿普司特需要较少的预筛查和监测。
阿普司特可能是一种治疗方案，适用于与临床试验参与者不同特征的患者。该建议的局限性在于缺乏对中度银屑病定义的共识、缺乏阿普司特使用的真实世界证据以及与耐受性相关的某些方面。
