Apremilast, alone or in combination with DMARDs, is recommended as an option for treating active psoriatic arthritis in adults with 3 or more tender joints and 3 or more swollen joints who have not responded to adequate trials of at least 2 standard DMARDs, given either alone or in combination.
Approval is conditional on the company providing apremilast with the discount agreed in the patient access scheme.
Prescribers should stop apremilast at 16 weeks if the psoriatic arthritis has not shown an adequate response according to Psoriatic Arthritis Response Criteria (PsARC), defined as an improvement in at least 2 of the 4 criteria (including joint tenderness or swelling score) with no worsening in any criteria. If a Psoriasis Area and Severity Index (PASI) 75 response is achieved, a dermatologist should decide whether to continue treatment based on skin response.
Treatment of patients already receiving apremilast who do not meet the above criteria may be continued until they and their NHS clinician consider it appropriate to stop.
In November, apremilast was approved by NICE for the treatment of psoriasis. The drug inhibits phosphodiesterase 4, causing elevation of intracellular cAMP levels and in turn downregulating the inflammatory response by modulating the expression of inflammatory cytokines including TNF.