Apremilast 10mg tablets

Pemphigus is a severe autoimmune blistering disorder that significantly affects patients’ quality of life. While corticosteroids and immunosuppressive agents are commonly used, they have substantial side effects, highlighting the need for safer alternatives. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, has shown efficacy in treating other autoimmune diseases and may offer promise for pemphigus. This systematic review evaluated the clinical outcomes, safety, and potential role of apremilast in the treatment of pemphigus by synthesizing available case reports and series. A literature search was conducted across multiple databases (PubMed, EMBASE, Cochrane, Web of Science, ScienceDirect, and Google Scholar) for case reports and series involving apremilast in pemphigus. Inclusion criteria were a confirmed pemphigus diagnosis and apremilast treatment. Five studies (four case reports and one case series) involving 7 patients were included. Apremilast led to significant clinical improvement in 4 patients, with reductions in disease activity, lesion severity, and symptom scores (Pemphigus Disease Area Index [PDAI], Autoimmune Bullous Skin Disorder Intensity Score [ABSIS], Visual Analog Scale [VAS], and Numerical Rating Score [NRS]). Increases in regulatory T cells and decreases in anti-desmoglein antibodies were observed. No serious adverse events were reported, although one study noted treatment failure, possibly due to short follow-up or concurrent infections. Apremilast appears to be a promising treatment for therapy-resistant or corticosteroid-intolerant pemphigus patients. Although the evidence is limited, it supports apremilast’s efficacy and favorable safety profile. Further research with larger sample sizes and randomized controlled trials is necessary to confirm these findings.

Abstract licence: CC BY-NC

Background and aimsThe latest advances in the treatment of vitiligo involve the introduction of Janus kinase inhibitors (JAKI) and small molecule inhibitors (SMI). These modern treatment modalities target specific inflammatory pathways that can improve outcomes for vitiligo in adults, adolescents, and children.MethodsWe did a literature search among PubMed, Scopus, and Web of Science, utilizing PRISMA guidelines. Articles included in the study were those reporting systemic medications using JAKI and SMI for vitiligo, categorized into subgroups of children (2-12), adolescents (12-18), and adults (over 18). We extracted information based on patient demographics, treatment regimens, efficacy outcomes, adverse effects, and follow-up data.ResultsAfter screening 987 studies, a total of 25 articles met the inclusion criteria and were included. The analysis demonstrated that JAKI, as well as the phosphodiesterase-4 Inhibitor (PDE4 Inhibitor), apremilast, showed notable efficacy in the treatment of vitiligo across various age groups. Among these, ritlecitinib was the most extensively studied, showing significant improvements in both Facial-VASI and Total-VASI scores, especially when combined with NB-UVB phototherapy. Tofacitinib demonstrated up to 75% repigmentation, particularly in sun-exposed areas and pediatric populations, with higher efficacy noted when used alongside phototherapy. Upadacitinib showed ≥ 35% improvement in Facial-VASI scores, though higher doses were associated with increased adverse events, including a serious nonfatal ischemic stroke. Baricitinib led to > 50% VASI improvement in 70.6% of patients when combined with NB-UVB. Apremilast showed partial disease control and up to 61.5% repigmentation, though it was generally less effective than corticosteroids in halting progression.ConclusionsJAKI and SMIs appear to be promising treatment options for vitiligo in adults, adolescents, and children, offering better efficacy than traditional treatments. However, some treatments like Apremilast had conflicting results about efficacy in vitiligo. Although these are notable findings, further research is required to establish their long-term safety, particularly in children and adolescents.

Abstract licence: CC BY

BackgroundRecently, the literature has expanded with peer-reviewed studies on immunomodulatory agents' efficacy on scalp psoriasis-which, in turn, widened knowledge gaps regarding these agents' relative effectiveness. We determined the relative efficacy of immunomodulatory monotherapies for scalp psoriasis.MethodsWe ran Bayesian network meta-analyses (NMAs) using outcomes related to Psoriasis Scalp Severity Index (PSSI) and scalp-specific Physician's Global Assessment of clear (0) or almost clear (1) (Sc-PGA 0/1).ResultsWe estimated the relative efficacy of 22 interventions (including placebo), and analyzed 9 outcomes, namely: proportion of participants who attained Sc-PGA 0/1, proportion of participants who achieved 100% improvement in PSSI (PSSI-100), and proportion of participants who achieved 90% improvement in PSSI (PSSI-90) at 8, 12, and 16 weeks.ConclusionsWe are the first to provide comparative evidence on the efficacy of newly investigated agents such as deucravacitinib, tildrakizumab, roflumilast and icotrokinra. In general, the IL-17 inhibitors (bimekizumab, ixekizumab, secukinumab, brodalumab) and IL-23 inhibitors (icotrokinra, guselkumab, tildrakizumab) were effective depending upon the outcome and time-point being considered. At 16 weeks, for PSSI-100, ixekizumab 150 mg at weeks 0, 2, 4, 8, and 12 ranked highest; at 16 weeks, for Sc-PGA 0/1 bimekizumab 320 mg every 4 weeks ranked highest; at 8 weeks, for PSSI-100 ixekizumab 80 mg every 2 weeks ranked highest; at 8 weeks, for Sc-PGA 0/1 secukinumab 300 mg at weeks 1, 2, 3 and then every 4 weeks ranked highest. Small-molecule therapies (apremilast, deucravacitinib, roflumilast) improved scalp psoriasis modestly. Our work would guide the design of future studies and clinical decision-making.

Abstract licence: CC BY