Benefits of Earlier Apremilast Initiation in Patients with Psoriasis and Limited Skin Involvement: Results from a Real-World Retrospective Study.

Introduction: Many patients with psoriasis remain on topical therapy despite meeting criteria for systemic therapy. Our objective was to estimate the effect of earlier initiation of apremilast on attaining body surface area (BSA) treatment targets in patients with psoriasis in a real-world setting.

Methods: This retrospective cohort study conducted in the OM1 database analyzed patients with psoriasis and a BSA value between ≥ 1 and ≤ 10% (on index date) who had initiated apremilast or a topical treatment. Relative risks were used to compare achieved BSA targets across treatment groups. Confounding, selection bias, and missing data may have been present, but measures were taken to limit their impact.

Results: Of 3589 apremilast initiators, 2073 (57.8%) initiated early (≤ 6 months after index date) and 1516 (42.2%) initiated late (> 6 months); separately, 9777 patients initiated their second or later topical treatment (topical users). Compared with early initiators, late initiators had higher BSA values at treatment initiation. Early apremilast initiators were more likely than topical users to achieve BSA ≤ 1% or ≥ 75% improvement in BSA (BSA-75) at 6 and 12 months after treatment initiation: for early apremilast initiators, the relative risks of achieving BSA ≤ 1% and BSA-75 compared with topical users were 1.54 (95% confidence interval [CI]: 1.27, 1.87) and 1.52 (95% CI: 1.21, 1.89), respectively, at 6 months, and 1.49 (95% CI: 1.23, 1.80) and 1.50 (95% CI: 1.22, 1.85), respectively, at 12 months.

Conclusions: Earlier initiation of apremilast, an oral systemic treatment, was associated with lower cumulative disease burden and increased likelihood of attaining BSA goals compared with topical users.