Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain.
Dermatol Ther. 2022 Nov;35(11):e15844. doi: 10.1111/dth.15844. Epub 2022 Oct 7.
Apremilast is an oral small molecule approved for the treatment of psoriasis, psoriatic arthritis and oral ulcers associated with Behçet's disease. This research was conducted to describe the characteristics of patients who received treatment with apremilast for a skin disorder, either before, during, or after a biological treatment, with the aim of analyze the reasons that lead to start this drug in real clinical practice or suspend it for another. A total of 41 patients were enrolled: nine (22.0%) had received biological treatment prior to apremilast, seven (17.0%) both before and after apremilast and 25 (61.0%) after apremilast. One patient received concomitant treatment with adalimumab and apremilast. Most patients (85.4%) received apremilast as treatment for psoriasis. Reasons for starting apremilast were lack of efficacy with previous treatments (85.4%) and adverse effects or contraindication to previous treatments (14.6%), without statistically significant differences between patients who had received a previous biologic and those who had not. Drug survival was not influenced by previous biological treatment, but we found an increased risk of drug discontinuation in patients with chronic kidney disease (log-rank p = 0.028). The main reason of apremilast withdrawal was lack of adequate disease control (60.0%), most of whom required treatment with biologics. Therefore, despite the extensive development of new therapies for psoriasis and other dermatological conditions, apremilast is a widely used drug even in patients who are candidates for biologic treatment. Its initiation is more frequent due to poor disease control than because of other therapies contraindications.
阿普米司特是一种口服小分子药物，已被批准用于治疗银屑病、银屑病关节炎和与白塞病相关的口腔溃疡。本研究旨在描述在接受生物治疗之前、期间或之后因皮肤疾病而接受阿普米司特治疗的患者的特征，以分析导致在实际临床实践中开始使用该药或因其他原因停药的原因。共纳入 41 例患者：9 例（22.0%）在接受阿普米司特治疗前接受过生物治疗，7 例（17.0%）在接受阿普米司特治疗前和后均接受过生物治疗，25 例（61.0%）在接受阿普米司特治疗后接受过生物治疗。1 例患者接受阿达木单抗和阿普米司特联合治疗。大多数患者（85.4%）接受阿普米司特治疗银屑病。开始使用阿普米司特的原因是先前治疗缺乏疗效（85.4%）和先前治疗的不良反应或禁忌（14.6%），接受过先前生物治疗的患者与未接受过的患者之间无统计学差异。药物生存时间不受先前生物治疗的影响，但我们发现慢性肾脏病患者的药物停药风险增加（对数秩检验 p=0.028）。阿普米司特停药的主要原因是疾病控制不佳（60.0%），其中大多数需要生物治疗。因此，尽管新的治疗银屑病和其他皮肤病的方法广泛发展，阿普米司特仍是一种广泛使用的药物，即使是那些适合生物治疗的患者。其起始更多是由于疾病控制不佳，而不是由于其他治疗的禁忌。
