Apremilast (Otezla)


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

Apremilast is typically prescribed for patients who have failed one or more disease-modifying drugs but are not suitable for biologic therapies. Plaque psoriasis is a form of psoriasis described as 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 to Take It

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

Clinical studies showed approximately 30% of patients had a decrease of 20% in the number of painful and swollen joints after 4 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 apremilast include diarrhea, nausea, upper respiratory tract infection, and headache. After two weeks of treatment, most patients who had symptoms of diarrhea and nausea no longer felt the symptoms without stopping treatment. More serious side effects include body weight loss 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 apremilast 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.  Apremilast does not lead to increased risk of infection.

Tell Your Doctor

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 affect how apremilast works.  Examples of those medications include Phenytoin, Carbamazepine, Primidone, Phenobarbital, Rifampin, and St. John’s Wort.

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. Tell your doctor if you become pregnant or plan to become pregnant. Apremilast’s effect on pregnancy is unknown, so it should be avoided during pregnancy. It is also unknown if Apremilast is excreted into breast milk. Use in caution if you are nursing. If you have kidney disease, you should inform your rheumatologist, as Apremilast’s dosages should be adjusted in patients with severe renal dysfunction.

Updated March 2019 by Suleman Bhana, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

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.

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