Apremilast monotherapy effective in oligoarticular psoriatic arthritis
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Treatment with apremilast alone is effective in patients with oligoarticular psoriatic arthritis, according to data published in The Journal of Rheumatology.
“Oligoarticular psoriatic arthritis, defined as <5 involved joints, affects [approximately] 50% of patients with PsA,” Alexis Ogdie, MD, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “Typical randomized controlled trials have not focused on this population, and, on average, patients enrolled have swollen and tender joint counts of 12 and 21, respectively. Despite the high prevalence of oligoarticular PsA, data are lacking in this population, and recommendations for management remain largely unaddressed.”
To analyze the efficacy of apremilast (Otezla, Celgene), as well as methotrexate, compared with biologic disease-modifying antirheumatic drugs, among patients with oligoarticular PsA, Ogdie and colleagues conducted a cohort study of participants in the Corrona Psoriatic Arthritis /Spondyloarthritis (PsA/SpA) Registry. According to the researchers, this multicenter registry recruited patients from more than 50 participating rheumatologists in the United States. A total of 1,593 patients with oligoarticular PsA were listed in the Corrona PsA/SpA Registry between June 2014 and March 2018.
For their own study, Ogdie and colleagues included 150 adults with PsA and oligoarthritis — defined as four or fewer swollen joints — who initiated apremilast, methotrexate or a biologic DMARD monotherapy as the first treatment within the registry between June 1, 2014, and March 1, 2018. In addition, all included patients were required to have had a 6-month follow-up visit with a time window of 3 to 9 months within the same period. Among the included registry participants, 34 received apremilast, 15 received methotrexate and 101 were treated with a biologic DMARD.
Outcomes at 6 months included disease activity and patient-reported outcome measures. The researchers assessed the proportion of patients with more than 1 swollen joint or more than one tender joint at baseline who achieved a swollen joint count of zero or one, or a tender joint count of zero or one, respectively. Other outcomes included the change from baseline in swollen and tender joint counts, and the change from baseline in the Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) score and core components.
According to the researchers, patients who initiated apremilast demonstrated higher disease activity at baseline than those who received methotrexate. At the 6-month follow-up, participants treated with apremilast had numerically greater disease activity improvements compared with the methotrexate group, and similar improvements to those who received biologic DMARDs.
“Although oligoarticular PsA, by definition, involves fewer joints than polyarticular PsA, the 2 subgroups had comparable disease burden,” Ogdie and colleagues wrote. “Oligoarticular PsA, while common, remains understudied and identification of effective management of this PsA phenotype is warranted. Despite use in a more often treatment-refractory patient population, the apremilast monotherapy group experienced improvements in disease activity measures and PROs; improvements were also experienced in the methotrexate group.”
“The improvements observed with apremilast monotherapy in this population were comparable with bDMARD monotherapy,” they added. “... Overall, findings from this exploratory analysis suggest that apremilast monotherapy is an effective treatment option for oligoarticular PsA.”
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