Factors Influencing the Choice of Apremilast or Methotrexate Treatment for Psoriasis | PracticeUpdate

Factors Influencing the Choice of Apremilast or Methotrexate Treatment for Psoriasis

Journal of the European Academy of Dermatology and Venereology: JEADV

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• This noninterventional study with 579 patients with psoriasis who were treated with either methotrexate or apremilast assessed the real-world factors associated with selecting either treatment. Patients who were older (OR, 1.04; P<.0001), with a history of cancer (OR, 2.16; P=.01 or chronic hepatopathy (OR, 3.27; P=.03), or not on systemic therapy for at least 6 months (OR, 3.24; P<.0001) had an increased likelihood of receiving an apremilast prescription. No association was observed between patient profile and the type of prescribing physician. 

• These findings indicate that, when considering oral treatment for psoriasis in a real-world setting, the choice of apremilast appears to be influenced by patient age and comorbidities such as chronic hepatopathy, wherein methotrexate is contraindicated, and history of cancer, in which biologics may be contraindicated.

– InYoung Kim, MD, PhD

http://www.practiceupdate.com/content/factors-influencing-the-choice-of-apremilast-or-methotrexate-treatment-for-psoriasis/88261

Abstract 

Apremilast (Otezlaâ, Celgene France), an oral phosphodiesterase-4 inhibitor, has been approved for treating moderate-to-severe chronic plaque psoriasis in adult patients failing to respond to, or having a contraindication to, or being intolerantto other systemic therapy including cyclosporine, methotrexateor phototherapy. We present the results of a non-interventional, cross sectional, multi-centre study, including 579 adults (≥18 years) who consulted for psoriasis and who were started on methotrexate (n=289) or apremilast (n=290) between October 2016 and January 19, 2018. The study aimed at assessing factors associated with choosing between apremilast and methotrexate in real-world clinical setting. Patient variables included demographics, disease characteristics, associated cardiovascular and metabolic comorbidities, history of cancer, chronic infection (hepatitis B and C, HIV), depression, type of prescribing doctor (hospital vs. private practice) and reason for prescription.

Apremilast was preferred for older patients, those with chronic hepatopathy for whom methotrexate was contraindi-cated, and those with a history of cancer for whom biologics were contraindicated. In the apremilast group, except for a lower rate of psoriatic arthritis, mean age, mean psoriasis duration and male predominance were comparable to those observed in other real-world studies.6–10 Comorbidity rates were also comparable,except for chronic hepatopathy (lower) and cardiovascular pathologies (lower). The percentage of patients with a cancer history was similar to that reported by Ighaniet al.9 Our patients were more frequently diagnosed with non-plaque psoriasis, and more were biologic-naive than those in other real-world studies.10The percentage of systemic-naive patients was comparable to that reported by Papadavid et al.6There was a trend here for favouring prescribing apremilast to patients with a history of depression. Patient choice led more often to prescribing apremilast. In conclusion, age, chronic hepatopathy or a cancer history may influence the prescribing choice between apremilast and methotrexate for psoriasis.

Journal of the European Academy of Dermatology and Venereology: JEADV

Factors That May Influence the Choice for Initiating Apremilast or Methotrexate Treatment for Psoriasis in Real-World Clinical Setting

J Eur Acad Dermatol Venereol 2019 Jul 16;[EPub Ahead of Print], AC Fougerousse, F Maccari, A Beauchet, J Parier, C Boulard, PA Becherel, N Quiles-Tsimaratos, T Le Guyadec, D Thomas-Beaulieu, B Halioua, E Begon, M Bastien, JL Perrot, V Pallure, P Bilan, M Steff, P Pfister, A Vermersch-Langlin, T Boyé, L Mery-Bossard, H Maillard, M Kemula, C Girard, C Poiraud, JB Monfort, I Kupfer-Bessaguet, M Perrussel, D Lons-Danic, N Sultan, E Lorier, M Zeitoun, L Wagner, G Gabison, E Mahé, GEM Resopso 

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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