Apremilast may improve nail psoriasis
Apremilast improved nail psoriasis at week 36, with improvement seen as early as week 8, according to a presentation at the European Academy of Dermatology and Venerology congress.
“Approximately 80% to 90% of those with psoriasis are estimated to have nail psoriasis during their lifetime,” Allen S.W. Oak, MD, of the department of dermatology at University of Alabama at Birmingham, and colleagues wrote. “Apremilast is an oral phosphodiesterase 4 inhibitor approved for treatment of moderate to severe plaque psoriasis and psoriatic arthritis. In ESTEEM 1 and ESTEEM 2 trials, Nail Psoriasis Severity Index (NAPSI) scores were examined ... and NAPSI respectively decreased by 43.6% and 60% at week 32 in each trial.”
In an investigator-initiated, open-label, single-arm study, researchers evaluated the safety and efficacy of apremilast 30 mg twice daily in 11 adults for the treatment of nail psoriasis. Endpoints included mean percentage change of modified NAPSI (mNAPSI) at week 36 as well as drug-related adverse events. A full study analysis was conducted at 52 weeks.
Of the six patients who completed the study, researchers observed an overall reduction of mNAPSI by 64.1%, 33.8 vs. 12.3, compared with baseline. Further analysis showed the nail with the highest baseline mNAPSI had a significant decrease in mean mNAPSI percent. In addition, the proportion of patients achieving a 75% or greater reduction was 27.2% of patients at week 12, 36.4% of patients at week 36 and 45.5% of patients at week 52.
Drug-related adverse events included nausea, abdominal pain and increased bowel movements; upper respiratory infections and headache were other possibly related adverse events.
“Improvement in nail psoriasis was observed with apremilast at week 36 when assessed via the primary endpoint of mNAPSI improvement. Visibly, nail improvement was observed early as week 8,” Oak and colleagues wrote. “[Gastrointestinal adverse events] were common as expected and should be discussed with patients.”
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Oak ASW, et al. Improvement of nail psoriasis with apremilast: Results of an investigator-initiated open label study. Presented at: European Academy of Dermatology and Venereology congress; Oct 29-31, 2020 (virtual meeting).
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