What it is
➝ Apremilast is an oral systemic medication used for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis.
➝ It belongs to a class of drugs called phosphodiesterase-4 (PDE4) inhibitors. By blocking PDE4, apremilast reduces the production of inflammatory mediators responsible for psoriasis symptoms.
➝ Unlike traditional systemic drugs (methotrexate, cyclosporine), apremilast is considered targeted therapy, offering a safer long-term option without the same risks of organ damage.
➝ It is not a biologic injection but works at the cellular signaling level to calm the immune system.
Why it’s done
→ Prescribed for patients who fail to respond to topical therapies or phototherapy.
→ Effective in treating skin lesions, scalp psoriasis, nail psoriasis, and psoriatic arthritis symptoms.
→ Offers a good option for patients who prefer oral medication over injections.
→ Chosen for those who cannot tolerate or are unsuitable for methotrexate, cyclosporine, or acitretin.
→ In Korea, apremilast is considered a step-up therapy before moving to expensive biologics, especially when safety is a priority.
Alternatives
→ Methotrexate: Widely used systemic drug but requires liver and blood monitoring.
→ Cyclosporine: Rescue therapy for rapid control, though not for long-term use.
→ Acitretin: Retinoid option, sometimes combined with light therapy.
→ Biologics: Stronger targeted injections (IL-17, IL-23, TNF-alpha inhibitors).
→ Phototherapy: Often used in milder or localized cases.
→ Topical therapies: Still useful in mild to moderate cases (steroids, vitamin D analogs).
Preparation
→ Before starting apremilast, patients usually undergo basic health evaluation, though it does not require extensive organ function testing like methotrexate or cyclosporine.
→ Doctors may check weight, mood history, and gastrointestinal health, since apremilast may cause weight loss and depression in rare cases.
→ Patients are counseled about gradual dose titration, as the drug must be introduced slowly to minimize gastrointestinal side effects.
→ No strict restrictions on alcohol, but maintaining a healthy lifestyle enhances effectiveness.
How it’s Done
→ Apremilast is taken orally in tablet form, twice daily.
→ A titration schedule is followed for the first 5 days to reduce nausea and diarrhea, after which the patient remains on the standard maintenance dose.
→ It does not require blood test monitoring as frequently as methotrexate or cyclosporine, making it more convenient.
→ In Korea, dermatologists provide patients with structured dosing calendars to ensure correct titration and adherence.
Recovery
→ Patients may start noticing improvements in itching and redness within 2–4 weeks.
→ Maximum benefits usually occur after 16 weeks of continuous treatment.
→ Psoriasis plaques gradually reduce in thickness and scaling.
→ Nail psoriasis and joint symptoms may take longer to improve.
→ Many patients report improved quality of life, mobility, and reduced discomfort.
Complications
→ Common side effects: Diarrhea, nausea, headache, and upper respiratory symptoms.
→ Weight loss: Some patients experience unintended loss of appetite and weight.
→ Mood changes: Rare but important—cases of depression and suicidal thoughts have been reported, so monitoring is essential.
→ Long-term safety: Generally safer than methotrexate or cyclosporine because it does not damage the liver or kidneys.
→ Drug interactions: Caution with strong enzyme inducers (e.g., rifampin, phenytoin) which can reduce apremilast levels.
Treatment Options in Korea
→ In Korea, apremilast is available in specialized dermatology and rheumatology clinics for psoriasis management.
→ It is often offered to patients who want an oral option but do not want the risks of methotrexate or cyclosporine.
→ Korean doctors often position apremilast as a bridge therapy before biologics, especially for those who prefer convenience and lower monitoring needs.
→ Clinics may combine apremilast with topical treatments or UV therapy for enhanced effect.
→ Patient follow-up in Korea usually includes weight checks, mood assessments, and progress tracking.
→ Apremilast is part of the modern psoriasis treatment landscape in Korea, giving patients a safer, non-injection option aligned with international treatment standards.
