Table 2.

Place of Apremilast in Psoriasis Management

• Apremilast can be used as monotherapy in patients with stable mild to moderate psoriasis and as combination therapy in moderate to severe psoriasis

• Efficacy of apremilast is comparable to systemic and biologic agents (particularly stable disease plaque psoriasis) and it is relatively safe

• Apremilast can be added to ongoing systemic therapy to enhance the response; it is recommended that systemic therapy should be continued for a minimum of 6 weeks to maintain remission

• A combination of apremilast and biologics offers better disease control than biologic monotherapy. Apremilast could serve as the agent of preference for maintaining remission induced by biologics

• Although apremilast is approved in moderate to severe plaque psoriasis, it has been found to be effective in other types of psoriasis, such as palmoplantar, nail, and scalp psoriasis

• Apremilast usually takes 4–6 weeks to show initial efficacy, hence therapy should be continued for a minimum of 8 weeks once initiated. Also, it is recommended to continue therapy for about 24 weeks for better efficacy

• Most importantly, the response to apremilast is very unpredictable in psoriasis, ie, it works in some patients very well whereas other patients may not respond at all