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What is Otezla (apremilast)?
It is also used to treat moderate to severe plaque psoriasis in patients who are candidates for phototherapy or systemic therapy.
Otezla works by reducing production of an enzyme known as phosphodiesterase 4 (PDE4). This may lead to a reduction in chemicals that cause inflammation in the body.
Common side effects of Otezla include:
Serious side effects of Otezla include:
Drug interactions of Otezla include:
- St. John's wort,
- and carbamazepine, which may reduce blood levels of Otezla by increasing its breakdown when taken together.
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Otezla during pregnancy. Pregnant women should be advised of the potential risk of fetal loss. Pregnancy planning and prevention should be considered for females of reproductive potential taking Otezla. It is unknown if Otezla is secreted into breast milk. Consult your doctor before breastfeeding.
What are the important side effects of Otezla (apremilast)?
The most common side effects associated with apremilast are:
It also can cause upper respiratory tract infections.
The following were also reported in clinical studies:
Otezla (apremilast) side effects list for healthcare professionals
The following adverse reactions are described elsewhere in the labeling:
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
Psoriatic Arthritis Clinical Trials
Otezla was evaluated in 3 multicenter, randomized, double-blind, placebo-controlled trials [Studies PsA-1, PsA-2, and PsA-3] of similar design in adult patients with active psoriatic arthritis.
- Across the 3 studies, there were 1493 patients randomized equally to placebo, Otezla 20 mg twice daily or Otezla 30 mg twice daily. Titration was used over the first 5 days.
- Placebo patients whose tender and swollen joint counts had not improved by at least 20% were re-randomized 1:1 in a blinded fashion to either Otezla 20 mg twice daily or 30 mg twice daily at week 16 while Otezla patients remained on their initial treatment.
- Patients ranged in age from 18 to 83 years, with an overall median age of 51 years.
The majority of the most common adverse reactions presented in Table 2 occurred within the first 2 weeks of treatment and tended to resolve over time with continued dosing.
The most commonly reported adverse reactions were:
- and nausea.
The most common adverse reactions leading to discontinuation for patients taking Otezla were:
- nausea (1.8%),
- diarrhea (1.8%),
- and headache (1.2%).
The proportion of patients with psoriatic arthritis who discontinued treatment due to any adverse reaction was 4.6% for patients taking Otezla 30 mg twice daily and 1.2% for placebo-treated patients.
Table 2: Adverse Reactions Reported in ≥2% of Patients on Otezla 30 mg Twice Daily and ≥1% Than That Observed in Patients on Placebo for up to Day 112 (Week 16)
|Preferred Term||Placebo||Otezla 30 mg BID|
|Day 1 to 5|
|Day 6 to Day 112|
|Day 1 to 5|
|Day 6 to Day 112|
|Diarrheaa||6 (1.2)||8 (1.6)||46 (9.3)||38 (7.7)|
|Nauseaa||7 (1.4)||15 (3.1)||37 (7.4)||44 (8.9)|
|Headachea||9 (1.8)||11 (2.2)||24 (4.8)||29 (5.9)|
|Upper respiratory tract infectionb||3 (0.6)||9 (1.8)||3 (0.6)||19 (3.9)|
|Vomitinga||2 (0.4)||2 (0.4)||4 (0.8)||16 (3.2)|
|Nasopharyngitisb||1 (0.2)||8 (1.6)||1 (0.2)||13 (2.6)|
|Abdominal pain upperb||0 (0.0)||1 (0.2)||3 (0.6)||10 (2.0)|
|a Of the reported gastrointestinal adverse reactions, 1 subject experienced a serious adverse reaction of nausea and vomiting in Otezla 30 mg twice daily; 1 subject treated with Otezla 20 mg twice daily experienced a serious adverse reaction of diarrhea; 1 patient treated with Otezla 30 mg twice daily experienced a serious adverse reaction of headache.|
b Of the reported adverse drug reactions none were serious.
c n (%) indicates number of patients and percent.
Other adverse reactions reported in patients on Otezla in clinical studies including extension studies:
Immune system disorders: Hypersensitivity
Investigations: Weight decrease
Nervous System Disorders: Migraine
Respiratory, Thoracic, and Mediastinal Disorders: Cough
Skin and Subcutaneous Tissue Disorders: Rash
*1 patient treated with Otezla 30 mg twice daily experienced a serious adverse reaction.
Psoriasis Clinical Trials
- The safety of Otezla was assessed in 1426 subjects in 3 randomized, double-blind, placebo-controlled trials in adult subjects with moderate to severe plaque psoriasis who were candidates for phototherapy or systemic therapy.
- Subjects were randomized to receive Otezla 30 mg twice daily or placebo twice daily. Titration was used over the first 5 days.
- Subjects ranged in age from 18 to 83 years, with an overall median age of 46 years.
The most commonly reported adverse reactions were:
- and upper respiratory tract infection.
The most common adverse reactions leading to discontinuation for subjects taking Otezla were:
- nausea (1.6%),
- diarrhea (1.0%),
- and headache (0.8%).
The proportion of subjects with psoriasis who discontinued treatment due to any adverse reaction was 6.1% for subjects treated with Otezla 30 mg twice daily and 4.1% for placebo-treated subjects.
Table 3: Adverse Reactions Reported in ≥1% of Subjects on Otezla and With Greater Frequency Than in Subjects on Placebo; up to Day 112 (Week 16)
|Otezla 30 mg BID|
|Diarrhea||32 (6)||160 (17)|
|Nausea||35 (7)||155 (17)|
|Upper respiratory tract infection||31 (6)||84 (9)|
|Tension headache||21 (4)||75 (8)|
|Headache||19 (4)||55 (6)|
|Abdominal pain*||11 (2)||39 (4)|
|Vomiting||8 (2)||35 (4)|
|Fatigue||9 (2)||29 (3)|
|Dyspepsia||6 (1)||29 (3)|
|Decreased appetite||5 (1)||26 (3)|
|Insomnia||4 (1)||21 (2)|
|Back pain||4 (1)||20 (2)|
|Migraine||5 (1)||19 (2)|
|Frequent bowel movements||1 (0)||17 (2)|
|Depression||2 (0)||12 (1)|
|Bronchitis||2 (0)||12 (1)|
|Tooth abscess||0 (0)||10 (1)|
|Folliculitis||0 (0)||9 (1)|
|Sinus headache||0 (0)||9 (1)|
|*Two subjects treated with Otezla experienced serious adverse reaction of abdominal pain.|
Severe worsening of psoriasis (rebound) occurred in 0.3% (4/1184) subjects following discontinuation of treatment with Otezla.
Behcet's Disease Clinical Trials
- Otezla was evaluated in a Phase 3, multicenter, randomized, placebo-controlled study (BCT-002) in adult patients with Behcet's Disease (BD) with active oral ulcers.
- A total of 207 patients were randomized to receive Otezla 30 mg twice daily or placebo twice daily.
- Titration was used over the first 5 days. After Week 12, all patients received treatment with Otezla 30 mg twice daily.
- Patients ranged in age from 19 to 72, with a mean age of 40 years.
The most commonly reported adverse reactions were:
- and upper respiratory tract infection.
The proportion of patients with BD who discontinued treatment due to any adverse reaction during the placebo-controlled period of the study, was 2.9% for patients treated with Otezla 30 mg twice daily and 4.9% for placebo-treated patients.
Table 4: Adverse Reactions Reported in ≥5% of Patients on Otezla and with at least 1% Greater Frequency than Patients on Placebo; up to Week 12
(N=103) n (%)
|Otezla 30 mg twice daily|
(N=104) n (%)
|Diarrheaa||21 (20.4)||43 (41.3)|
|Nauseaa||11 (10.7)||20 (19.2)|
|Headache||11 (10.7)||15 (14.4)|
|Upper respiratory tract infection||5 (4.9)||12 (11.5)|
|Abdominal pain upper||2(1.9)||9 (8.7)|
|Back pain||6 (5.8)||8 (7.7)|
|Viral upper respiratory tract infection||5 (4.9)||7 (6.7)|
|Arthralgia||3 (2.9)||6 (5.8)|
|a There were no serious adverse reactions of diarrhea, nausea or vomiting.|
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Related Disease Conditions
Buildup of uric acid crystals in a joint causes gouty arthritis. Symptoms and signs include joint pain, swelling, heat, and redness, typically of a single joint. Gout may be treated with diet and lifestyle changes, as well as medication.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. The 16 characteristic early RA signs and symptoms include the following. Anemia Both sides of the body affected (symmetric) Depression Fatigue Fever Joint deformity Joint pain Joint redness Joint stiffness Joint swelling Joint tenderness Joint warmth Limping Loss of joint function Loss of joint range of motion Many joints affected (polyarthritis)
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Scalp Psoriasis (Psoriasis of the Scalp)
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Psoriasis is an incurable chronic autoimmune disorder of the skin that causes patches of thick, flaky, scaly skin, mostly around the scalp, knees, and elbows, though any skin surface may be involved. Some people experience only small patches while others have red, inflamed skin and think scaly patches all over the body. The exact cause of psoriasis is not clear, but it isn’t contagious.
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Non-Radiographic Axial Spondyloarthritis (nr-axSpA)
Non-radiographic spondyloarthritis (nr-axSpA) is an inflammatory arthritis that mainly affects the joints of the spine. Morning stiffness and back pain are the usual symptoms of nr-axSpA. Nonsteroidal anti-inflammatory drugs, exercise, and biologics are treatments for nr-axSpA.
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