Psoriatic arthritis

Active Ingredient: Apremilast

Indication for Apremilast

Population group: only adults (18 years old or older)
Therapeutic intent: Curative procedure

Apremilast, alone or in combination with Disease Modifying Antirheumatic Drugs (DMARDs), is indicated for the treatment of active psoriatic arthritis (PsA) in adult patients who have had an inadequate response or who have been intolerant to a prior DMARD therapy.

For this indication, competent medicine agencies globally authorize below treatments:

30 mg twice daily after initial titration, approximately 12 hours apart, from Day 6 and thereafter

For:

Dosage regimens

Oral, 10 milligrams apremilast, at morning, one dose, over the duration of 24 hours. Afterwards, oral, 10 milligrams apremilast, at morning, one dose, over the duration of 12 hours. Afterwards, oral, 10 milligrams apremilast, at evening, one dose, over the duration of 12 hours. Afterwards, oral, 10 milligrams apremilast, at morning, one dose, over the duration of 12 hours. Afterwards, oral, 20 milligrams apremilast, at evening, one dose, over the duration of 12 hours. Afterwards, oral, 20 milligrams apremilast, at morning, one dose, over the duration of 12 hours. Afterwards, oral, 20 milligrams apremilast, at evening, one dose, over the duration of 12 hours. Afterwards, oral, 20 milligrams apremilast, at morning, one dose, over the duration of 12 hours. Afterwards, oral, 30 milligrams apremilast, at morning, one dose, over the duration of 12 hours. Afterwards, oral, 30 milligrams apremilast, once every 12 hours at morning.

Detailed description

The recommended dose of apremilast for adult patients is 30 mg taken orally twice daily. An initial titration schedule is required as shown below in table 1.

Table 1. Dose titration schedule for adult patients:

Day 1Day 2 Day 3 Day 4 Day 5 Day 6 &
thereafter
AM AM PM AM PM AM PM AM PM AM PM
10 mg 10 mg 10 mg 10 mg 20 mg 20 mg 20 mg 20 mg 30 mg 30 mg 30 mg

No re-titration is required after initial titration.

The recommended twice daily apremilast dose should be taken approximately 12 hours apart (morning and evening), with no food restrictions.

If patients miss a dose, the next dose should be taken as soon as possible. If it is close to the time for their next dose, the missed dose should not be taken and the next dose should be taken at the regular time.

During pivotal trials the greatest improvement was observed within the first 24 weeks of treatment for PsA. If a patient shows no evidence of therapeutic benefit after this time period, treatment should be reconsidered. The patient’s response to treatment should be evaluated on a regular basis.

Dosage considerations

It can be taken either with or without food.

Active ingredient

Apremilast

Apremilast, an oral small-molecule inhibitor of phosphodiesterase 4 (PDE4), works intracellularly to modulate a network of pro-inflammatory and anti-inflammatory mediators. PDE4 is a cyclic adenosine monophosphate (cAMP)-specific PDE and the dominant PDE in inflammatory cells. PDE4 inhibition elevates intracellular cAMP levels, which in turn down-regulates the inflammatory response by modulating the expression of TNF-α, IL-23, IL-17 and other inflammatory cytokines.

Read more about Apremilast

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