An institution-based non-randomised prospective study to estimate the efficacy and adverse effect profile of apremilast for moderate to severe refractory palmoplantar psoriasis

Background: Psoriasis is an immune-mediated inflammatory papulo-squamous disorder presenting as chronic plaque, pustular, erythrodermic, nail, scalp, drug induced, inverse, guttate etc. Palmoplantar psoriasis causes significant functional, cosmetic and psychological disability. Apremilast is a relatively newer drug being PDE-4 inhibitor, having negligible adverse effects with minimum blood monitoring. Methods: It is an institution-based, non-randomised, prospective study conducted over a period of 3 months. 42 patients of moderate to severe disease (assessed using PPPASI), refractory to conventional line of therapy (for atleast 3 months) or had contraindications for the same were selected from our Dermatology OPD. Follow up was done monthly for 6 months. Results: 42% of the patients were good responders. 1 patient did not respond and 2 had progression of the disease. There was a decrease in the mean DLQI from a baseline of 25 to less than 15 by the end of 1st month and around 5 by the end of 6th month.60% of patients showed onset of response by the 1st month. 45% of the patients showed adverse effects, mostly being nausea followed by dizziness. Conclusions: From our study and those in the existing literature, it can be inferred that apremilast is a promising drug for palmoplantar as well as other forms of psoriasis, especially in patients with comorbidities or treatment refractory psoriasis.