otezla ® - apremilast manufacturer: celgene corporation fda approval date: 9/23/14
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Otezla® - apremilast
Manufacturer: Celgene Corporation
FDA Approval Date: 9/23/14
Otezla®- apremilast
Clinical Application
• Indications:• Treatment of moderate to severe plaque
psoriasis in patients who are candidates for phototherapy or systemic therapy
• Treatment of active psoriatic arthritis in adults
• Place in therapy:• Oral alternative to Methotrexate and
retinoids
Otezla®- apremilast
Clinical Application• Contraindications:
• Hypersensitivity to apremilast or any component of the formulation
• Warnings: • Depression, suicidal ideation, and mood changes
have been reported
• May cause weight loss
• Precautions:• Systemic exposure increased in patients with CrCl
<30 ml/min
Otezla®- apremilast
Clinical Application
• Pregnancy:• Category C
• Lactation:• Excretion in breast milk is unknown, use
caution
Otezla®- apremilast
Drug Facts
• Pharmacology:
Inhibits phosphodiesterase-4 (PDE4) preventing it from degrading cyclic adenosine monophosphate (cAMP) to AMP resulting in increased cAMP levels intracellularly. Cyclic AMP down regulates inflammatory response through several inflammatory mediators.
Otezla®- apremilast
Drug Facts
• Pharmacokinetics:
A Well absorbed; ~73% bioavailability
D Vd 87 L; 68% protein bound
M Hepatic: Major CYP3A4 Minor CYP1A2 and CYP2A6
E t1/2 6-9h; 58% in urine, 39% in feces
Otezla®- apremilast
Drug Interactions
• Drug Interactions – Object Drugs: • None
Otezla®- apremilast
Drug Interactions
• Drug Interactions – Precipitant Drugs: • Bosentan: ↓ concentration
• Strong CYP3A4 inducers: ↓concentration
• Dabrafenib: ↓ concentration
• Deferasirox: ↓ concentration
• Siltuximab: ↓ concentration
• St. John’s Wort: ↓ concentration
• Tocilizumab: ↓ concentration
Otezla®- apremilast
Adverse Effects
• Common Adverse Effects:
• Serious Adverse Effects:
Diarrhea (9%) [2%] Nausea (9%) [3%]
Headache (6%) [2%] URI (4%) [2%]
Nasopharyngitis (3%) [2%] Vomiting (3%) [0.4%]
Abdominal pain (2%) [0.2%]
Weight Loss (10-12%) [3-5%]
Depression (1%) [0.8-1.3%]
Otezla®- apremilast
Monitoring Parameters
• Efficacy Monitoring:• Signs and Symptoms of
Psoriasis/psoriatic arthritis within 3 months of initiation
• Toxicity Monitoring:• SCr: 3 months and annually
• Weight Loss: 3 months
• Depression: 3 months
Otezla®- apremilast
Prescription Information
• Dosing: 30 mg BID• Titration:
• Cost: UpToDate.com Accessed 11/03/2014
• Starter Pack: $1012
• 30 mg Tablets #60: $2250
Day 1
Day 2 Day 3 Day 4 Day 5 Day 6
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
Otezla®- apremilast
Literature Review
• Phase 3 Psoriatic Arthritis Long-term Assessment of Clinical Efficacy (PALACE) Trial
• Randomized, placebo controlled study
• Included 504 patients from 13 countries
Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020-26
Otezla®- apremilast
Literature Review• Phase 1: 24 weeks
• 1:1:1 randomization to receive either apremilast 30 mg BID, apremilast 20 mg BID, or placebo
• Phase 2: 28 weeks • Patients who received placebo in Phase 1 were
randomized 1:1 to receive apremilast 20 mg BID or apremilast 30 mg BID
• Patients receiving apremilast in Phase 1 remained on that dose
Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020-26
Otezla®- apremilast
Literature Review
• Primary Endpoint: Proportion of patients with 20% improvement in modified ACR response criteria at week 16
• Secondary Endpoints: • Change from baseline in Health Assessment
Questionnaire- Disability Index (HAQ-DI) at week 16
• Improvement in S/Sx of PsA, physical function, and psoriasis at 24 weeks
Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020-26
Otezla®- apremilast
Literature Review
• Baseline Characteristics
Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020-26
Parameter PlaceboApremilast 20 mg BID
Apremilast 30 mg BID
Age (years) 51.1 48.7 51.4
BMI 31.1 30.9 30.6Mean duration of PsA (years) 7.3 7.2 8.1
Mean HAQ-DI (0-3) 1.2 1.2 1.2
Psoriasis involvement of BSA 3% or more (n) 68 77 82
Mean PASI Score (0-72) 9.1 7.4 9.2
Otezla®- apremilast
Literature Review
Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020-26
Otezla®- apremilast
Literature Review
Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020-26
Otezla®- apremilast
Literature Review
Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020-26
Otezla®- apremilast
Summary
• Apremilast is an effective oral agent for the treatment of psoriasis and psoriatic arthritis
• Maintenance Dose: 30 mg BID with dosing adjustment for CrCl <30 ml/min
• Weight and signs of depression must be monitored for as these are potentially serious adverse effects
Otezla®- apremilast
References
1. http://www.otezla.com
2. Otezla (apremilast) package insert. Celgene Corporation. Sept. 2014.
3. Apremilast. Lexicomp Drug Information. Accessed through UpToDate. Accessed on Nov 3, 2014.
4. Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020-1026
5. Papp KA, et al. JEADV 2013,27, e376-383