Apremilast (Otezla)

medication bottles

Fast Facts

  • During treatment with Otezla, it is important to monitor your weight. If you experience unexplained weight loss you should contact your doctor immediately, as this could indicate a problem, and discontinuation of the medication may be considered.
  • Otezla can affect your mood. If you have underlying mood disorder, you should discuss it with your primary rheumatologist prior to initiation of treatment.
  • Tell your doctor if you become pregnant or plan to become pregnant. Otezla’s effect on pregnancy is unknown, so it should be avoided during pregnancy. It is also unknown if Otezla is excreted into breast milk. Use in caution if you are nursing.
  • If you have kidney disease you should inform your rheumatologist, as Otezla’s dosages should be adjusted in patients with severe renal dysfunction.
  • Notify your doctor before any surgeries while taking this medication.

Apremilast (Otezla) is a small molecule prescription medicine that is approved to treat psoriatic arthritis and moderate to severe plaque psoriasis patients that are candidates for phototherapy (treatment of the skin with an ultraviolet light source). Apremilast slows the production of an enzyme called phosphodiesterase 4 (PDE4) and leads to a reduction in the inflammation.

Uses

Otezla is considered a small molecule medication and has two approved uses. It was approved by the U.S. Food and Drug Administration in 2014 to treat adults with moderate to severe plaque psoriasis and/or active psoriatic arthritis. It is typically prescribed for patients who have failed one or more disease-modifying drugs but are not appropriate for biologic therapies. Plaque psoriasis is a form of psoriasis that is characterized by thick patches of inflamed, scaly skin due to an overgrowth of skin cells. Psoriatic arthritis is a form of arthritis that affects some people with psoriasis, and common signs and symptoms include joint pain, stiffness, and swelling.

How it works

Otezla is believed to block an enzyme called phosphodiesterase 4 (PDE4) that is found in inflammatory cells, and is thought to decrease the overall production of the molecules that cause inflammation.

Dosing

Otezla comes in 10 mg, 20 mg, and 30 mg tablets. Dosing for psoriatic arthritis and plaque psoriasis are the same. Dosing begins at 10 mg on day one with a gradual increase over 5 days up to max dose of 30 mg twice a day. The reason for this is to reduce nausea and diarrhea associated with initial treatment Otezla can be taken with our without food. Tablets should not be crushed, split, or chewed.

Time to effect

Clinical studies on Otezla showed 1 in 3 people reached 75% clearer skin after four months. It is a chronic medication that will be used continuously as long as it is effective and well tolerated.

Side effects

The most common side effects of Otezla include diarrhea, nausea, upper respiratory tract infection, and headache. After two weeks of treatment most patient’s diarrhea and nausea symptoms resolved without stopping treatment. More serious side effects include lost body weight and depression. Tell your doctor if you are having any feelings of depression, suicidal thoughts, or suicidal behavior. Your doctor may also have to decide if you should continue to take Otezla if significant weight loss occurs.

Many patients do not experience side effects; however, for those who do, many of the minor side effects will improve with time. Side effects should be reported immediately and discussed with your rheumatologist.

Stop taking Otezla immediately if you experience a severe allergic reaction and seek medical attention.

Drug interactions

Be sure to tell your doctor about all of the medications you are taking, including over-the-counter drugs and natural remedies, as some of these could increase the risk of Otezla toxicity. Certain medications can cause a decrease in Otezla blood levels, leading to a loss of efficacy. Examples of those medications include Phenytoin, Carbamazepine, Primidone, Phenobarbital, Rifampin, and St. John’s Wort.

Information to discuss with health care providers

Be sure to tell your other physicians that you are taking this drug, as well as any other medications you are taking. Also notify your physician you are taking this before any surgery. Because this medication can lower your immunity, it is important that you discuss this with any physician treating you for an infection, as this may lead to a different evaluation or treatment. You should also talk to your doctor about whether you should stop using Otezla if you are about to have surgery. When Otezla treatment is discontinued, its beneficial effects on arthritis symptoms gradually disappear over a period of 2-8 weeks.

It is very important to inform your physicians if you are pregnant or plan to become pregnant. Due to the lack of evidence in pregnancy and lactation, possible risk may be associated with Otezla. Women who are taking Otezla may want to discuss birth control methods with their primary doctor or gynecologist.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

© 2016 American College of Rheumatology