Table 3.

Recommendations on the Use of Apremilast for Psoriasis in Special Populations

Special Conditions	Expert Panel Recommendations Regarding Apremilast Use
Children	Apremilast dosage in the pediatric age group should be individualized
Patients with comorbidity/polypharmacy	Conventional agents should be carefully evaluated in each patient considering the possible organ impairment, comorbidities, concomitant medications, and contraindications. Additional care is recommended in the population aged >65 years
Patients with depression	Careful risk–benefit analysis of apremilast use is recommended by means of the complete history of psychiatric symptoms, drug history, vigilant monitoring by caregivers, and cessation of therapy if a new psychiatric symptom is seen
Reproductive age group	The panel recommended judicious use in reproductive-age females and cessation of therapy prior to conception
Obesity and weight loss	Consensus was in favor of withdrawing the drug in case of >10% weight loss than baseline. But at the same time, apremilast may be of particular interest in patients with psoriasis with obesity and obesity-related comorbidities
HIV patients	Owing to its unique immunomodulatory action, apremilast can be considered as a first-line therapy in HIV patients, but the decision should be taken in collaboration with the infectious disease specialist
Patients with hepatitis B or C	Apremilast can be considered in patients with HBV or HCV infection and a hepatologist should be consulted only in case of clinically significant liver enzyme elevation (3–5 times more than the upper normal limit)
Patients at risk of developing tuberculosis	Apremilast can be considered in the treatment of psoriasis in patients with active or latent TB provided they are not on active rifampicin therapy
Vaccination	The decision regarding vaccination during apremilast therapy should be taken after considering the risk–benefit ratio