Apremilast

What is Apremilast?

• Apremilast (Otezla) is in a class of medications called disease modifying antirheumatic drugs (DMARDs)
• DMARDs are a slow acting but effective treatment for rheumatoid arthritis and other form of inflammatory arthritis.
• Apremilast is used in the treatment of psoriatic arthritis, as well as psoriasis.

What is the typical dose for apremilast?

• 30 mg twice per day given by mouth, although smaller doses may be used, particularly when starting.

How does apremilast work?

• Apremilast is a relatively new DMARD, approved for use in Canada in 2014
• Apremilast works by blocking the effect of phosphodiesterase 4 (PDE4).  By doing this, it can help decrease the body’s inflammatory response, thereby decreasing joint inflammation and psoriatic activity.
• There is no clear data yet to suggest apremilast is a better medication than other new medications for rheumatoid arthritis called biologics.

If I start apremilast, can I stop my other DMARDs?

• Most rheumatologists will suggest you continue with at least methotrexate, assuming you have not had side effects, in addition to apremilast. Studies have shown it works significantly better when combined with methotrexate.
• Keep in mind: In most instances, your rheumatologist has recommended you start a new medication because your psoriatic arthritis has not been well controlled. It is important to try to control your disease as best as possible first, which may mean continuing all DMARDs for some time, before trying to decrease them.

What are the possible side effects of apremilast?

• While generally well tolerated, apremilast may cause:
  • Upset Stomach
  • Increase your risk for serious infections
  • Depressed mood
  • Significant weight loss

What can I do to decrease my risk of side effects?

• Stop apremilast any time you have a fever. It is usually safe to resume it once you are better.
• Discuss with your rheumatologist if you start to notice a change in mood or weight.
• Follow your rheumatologist’s instructions for medication monitoring.
• Let your physician know if you have any changes in your medical history.
• Ensure your physician knows all the medications you are on, as apremilast can cause serious interactions with some medications.

What should I do if I miss my dose?

• If you miss your dose, do not take an extra dose, but just resume your normal routine.  As long as this does not happen regularly, you will likely not feel any ill effects.

How can I safely stop apremilast?

• It is safe to just stop apremilast; you do not need to slowly reduce the dose. However, keep in mind, if you were gaining any benefit, it will usually take a few weeks to lose it.