Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor.

Abstract

OBJECTIVES:

Apremilast, an oral phosphodiesterase 4 inhibitor, regulates inflammatory mediators. Psoriatic Arthritis Long-term Assessment of Clinical Efficacy 1 (PALACE 1) compared apremilast with placebo in patients with active psoriatic arthritis despite prior traditional disease-modifying antirheumatic drug (DMARD) and/or biologic therapy.

METHODS:

In the 24-week, placebo-controlled phase of PALACE 1, patients (N=504) were randomised (1:1:1) to placebo, apremilast 20 mg twice a day (BID) or apremilast 30 mg BID. At week 16, patients without ≥20% reduction in swollen and tender joint counts were required to be re-randomised equally to either apremilast dose if initially randomised to placebo or remained on their initial apremilast dose. Patients on background concurrent DMARDs continued stable doses (methotrexate, leflunomide and/or sulfasalazine). Primary outcome was the proportion of patients achieving 20% improvement in modified American College of Rheumatology response criteria (ACR20) at week 16.

RESULTS:

At week 16, significantly more apremilast 20 mg BID (31%) and 30 mg BID (40%) patients achieved ACR20 versus placebo (19%) (p<0.001). Significant improvements in key secondary measures (physical function, psoriasis) were evident with both apremilast doses versus placebo. Across outcome measures, the 30-mg group generally had higher and more consistent response rates, although statistical comparison was not conducted. The most common adverse events were gastrointestinal and generally occurred early, were self-limiting and infrequently led to discontinuation. No imbalance in major adverse cardiac events, serious or opportunistic infections, malignancies or laboratory abnormalities was observed.

CONCLUSIONS:

Apremilast was effective in the treatment of psoriatic arthritis, improving signs and symptoms and physical function. Apremilast demonstrated an acceptable safety profile and was generally well tolerated.

CLINICAL TRIAL REGISTRATION NUMBER:

NCT01172938.

• Authors: Arthur Kavanaugh, Philip J Mease, Juan J Gomez-Reino, Adewale O Adebajo, Jürgen Wollenhaupt, Dafna D Gladman, Eric Lespessailles, Stephen Hall, Marla Hochfeld, ChiaChi Hu, Douglas Hough, Randall M Stevens, Georg Schett
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 73 Issue 6 Pg. 1020-6 (Jun 2014) ISSN: 1468-2060 [Electronic] England
• PMID: 24595547 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antirheumatic Agents
• Phosphodiesterase 4 Inhibitors
• Thalidomide
• apremilast
• Methotrexate

Topics

• Administration, Oral
• Adult
• Aged
• Antirheumatic Agents (administration & dosage)
• Arthritis, Psoriatic (drug therapy)
• Double-Blind Method
• Drug Administration Schedule
• Drug Therapy, Combination (methods)
• Female
• Humans
• Male
• Methotrexate (administration & dosage)
• Middle Aged
• Phosphodiesterase 4 Inhibitors (administration & dosage)
• Psoriasis (drug therapy)
• Thalidomide (administration & dosage, analogs & derivatives)
• Treatment Outcome