In patients with psoriatic disease, phosphodiesterase 4 inhibitor (PD4) apremilast was found to be associated with weight loss and improved disease activity, according to study results published in Rheumatology.

In psoriasis and psoriatic arthritis (PsA), obesity, type 2 diabetes, and cardiovascular disease are common and thought to be involved in disease progression and treatment outcomes. Weight loss of 5% or more has been shown to improve PsA disease activity. In previous studies, apremilast was associated with weight loss in PsA, with other studies suggesting additional cardiometabolic benefits.

The current study was conducted to evaluate the effect of apremilast on body weight and composition, glucose homeostasis, lipid profiles, and vascular function, as well assess the relation between weight change and therapeutic response. 


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The prospective, open label study (Immune Metabolic Associations in Psoriatic Arthritis [IMAPA]; ClinicalTrials.gov Identifier: NCT03399708) included 60 adult patients (median age, 54.5 years; 63% women, median body mass index [BMI], 33.2) with psoriasis and PsA. Participants received 30 mg apremilast twice daily or once daily, if they were unable to tolerate the full dose. Assessments for cardiometabolic, anthropometric, and disease activity were completed at baseline, 1, 3, and 6 months. Additional measurements including endothelial function, body composition, and adipocyte morphology were collected from a subgroup of participants.

After 6 months of apremilast treatment, the researchers observed mean decreases in weight (2.2 kg; 95% CI, 1.4-3.0 kg; P <.001), BMI (0.8; 95% CI, 0.5-1.2; P <.001), total abdominal fat (0.52 L; 95% CI, 0.08-0.96 L; P =.022), and principally subcutaneous adipose tissue (0.37 L; 95% CI, 0.05-0.68 L; P =.022). No changes were observed in adipocyte diameter, hemoglobin A1c (HbA1c), glucagon-like peptide 1 (GLP-1), lipids, and vascular function.

Researchers noted improvements in psoriatic disease activity. A total of 8 of the 49 participants (16.3%) who completed the study at month 6 and had available data achieved minimal disease activity. However, disease activity was not correlated with weight change.

Study limitations included the small sample size, short duration, and the lack of a placebo group.

Researchers concluded, “Following apremilast treatment, we observed improvements in psoriatic disease activity and weight loss, primarily of abdominal subcutaneous fat. The clinical disease activity response with apremilast was independent of weight change, suggesting the main mechanism of action of apremilast in psoriatic disease is likely through direct immunological rather than metabolic effects.”

Disclosure: This research was supported by Amgen (formerly Celgene). Please see the original reference for a full list of disclosures.

Reference

Ferguson LD, Cathcart S, Rimmer D, et al. Effect of the phosphodiesterase 4 inhibitor apremilast on cardiometabolic outcomes in psoriatic disease — results of the IMAPA study. Rheumatology. Published online June 7, 2021. doi:10.1093/rheumatology/keab474