ABSTRACT
Apremilast (Otezla) is a sulfonyl isoindole type compound with a similar structure to crisaborole. Apremilast is an oral, small-molecule inhibitor of phosphodiesterase 4 (PDE4), an enzyme that breaks down cyclic adenosine monophosphate (cAMP). Apremilast is well absorbed orally and extensively metabolised by cytochrome oxidative metabolism, primarily CYP3A4. Apremilast was first licensed by the FDA for use in psoriatic arthritis in early 2014. Later that year, a license was extended to adults with moderate-to-severe chronic plaque psoriasis who qualified for phototherapy or systemic therapy. Apremilast is still within patent, and so there is no generic formulation. The value of Apremilast in treating patients who may be already psychologically affected by chronic plaque psoriasis and debilitating psoriatic arthritis needs to be evaluated, and patients need to be counselled and followed closely for signs of increased mental health issues such as depression or suicidal ideation.
