Apremilast Monotherapy Proves Effective Treatment for Psoriatic Arthritis

Apremilast monotherapy is a more effective treatment option for patients with oligoarticular psoriatic arthritis (PsA) when compared with methotrexate (MTX) and biologic disease-modifying antirheumatic drug (bDMARD) initiators, according to a study published in The Journal of Rheumatology.¹ Oligoarticular PsA affects roughly 50% of patients with PsA and is defined as having <5 involved joints.

“Although oligoarticular PsA, by definition, involves fewer joints than polyarticular PsA, the 2 subgroups had comparable disease burden,” stated investigators. “Oligoarticular PsA, while common, remains understudied and identification of effective management of this PsA phenotype is warranted.”

Investigators derived their data from the Corrona Psoriatic Arthritis/Spondyloarthritis (PsA/SpA) Registry, which actively recruits patients from over 50 rheumatologists across the United States. In this cohort study, participants aged ≥ 18 years with oligoarthritis PsA received initial apremilast, MTX, or dDMARD monotherapy between June 1, 2014, and March 1, 2018.

Patients scheduled a 6-month follow-up visit, which included disease activity assessment and patient-reported outcome (PRO) measures. Fatigue, achieving the minimal clinically important difference (MCID; ≥ 0.35-point decrease) in the Health Assessment Questionnaire–Disability Index (HAQ-DI) score, and symptoms of nail psoriasis were addressed. Additionally, investigators studied the proportion of patients with >1 swollen (SJC) or >1 tender joint count (TJC) at baseline who had achieved a score 0 or 1 throughout the study. Changes from baseline in Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) scores were noted.

In total 1593 patients were registered during this time, with 150 initiating either apremilast monotherapy (n=34), MTX (n=15), or bDMARD (n=101). Investigators stated that patients in the apremilast group tended to have higher levels of disease activity at baseline (cDAPSA score of >13), had fewer patients with minimal disease activity (MDA) at baseline, and had higher PRO and HAQ-DI scores at baseline when compared with the other 2 groups.

At the 6-month follow-up visit, those in the apremilast had significantly better disease activity improvements than the MTX group and comparable improvements compared with the bDMARD group. Improvements in cDAPSA scores were higher in the apremilast group (-1.5), when compared with MTX (-0.2) and bDMARD (-0.1). Those placed in the high disease activity category at baseline were more likely to achieve low disease activity (LDA) or remission (REM) in the apremilast group as well.

Further, the apremilast monotherapy cohort boasted a greater proportion of patients who reported SJC > 1 or TJC > 1 at baseline that were able to obtain an SJC ≤ 1 or TJC ≤ 1 at the 6-month follow up. Mean changes were also higher in the apremilast group (−0.4 and −0.4) when compared with MTX (0.1 and −0.3) or bDMARD (0.2 and −0.1). Nail psoriasis improved for patients receiving apremilast in greater proportions than the other groups, although results were more similar in the bDMARD group.

The study was limited by the small sample size and only patients who attended the 6-month follow-up visit were analyzed, which may have led to selection bias.

“Overall, findings from this exploratory analysis suggest that apremilast monotherapy is an effective treatment option for oligoarticular PsA,” concluded investigators.

Reference:

Ogdie A, Liu M, Glynn M, et al. Descriptive Comparisons of the Effect of Apremilast and Methotrexate Monotherapy in Oligoarticular Psoriatic Arthritis: The Corrona Psoriatic Arthritis/Spondyloarthritis Registry Results. J Rheumatol. 2021;48(5):693-697. doi:10.3899/jrheum.191209