银屑病药物阿普斯特的不良反应及禁忌概述

Introduction: Apremilast is a new oral, small molecule phosphodiesterase 4 (PDE4) inhibitor. It inhibits PDE4 activity, increases intracellular cyclic adenosine monophosphate levels, further regulates the expression of tumor necrosis factor and other inflammatory cytokines, and ultimately inhibits inflammatory responses. This article mainly writes about the indications, adverse reactions and management, medication contraindications, effects and efficacy of Apremilast.

Indications

Active psoriatic arthritis (PsA): This is a form of arthritis that primarily affects people with psoriasis. Joint pain, stiffness, and swelling are the main signs and symptoms of psoriatic arthritis.

Plaque psoriasis: This is a chronic autoimmune disease that usually presents with red patches and white scales on the skin.

Behcet's disease: This is a rare systemic vasculitic disease that may cause oral and genital ulcers, skin lesions, and eye inflammation.

Adverse reactions and management

1. Diarrhea: Diarrhea is a common adverse reaction when using Apremilast, with an incidence rate of approximately 17.8%. Management may include dosage adjustments, use of antidiarrheal medications, and ensuring adequate hydration.

2. Nausea: The incidence of nausea is about 16.6%. Tolerability can be improved by slowly increasing the dose, and patients are advised to follow medical advice, which may include the use of anti-nausea medications.

3. Upper respiratory tract infection: The incidence of upper respiratory tract infection is about 8.4%. Patients should avoid contact with people with colds or flu and practice good hygiene.

4. Headache: Headache is also one of the adverse reactions that patients may encounter, with an incidence rate of approximately 4.1%. It can usually be managed with over-the-counter pain relievers.

5. Weight loss: Apremilast may cause weight loss, so weight needs to be monitored regularly.

6. Changes in depressive mood: In view of the possibility of a mild increase in the risk of depression, patients, their caregivers, and family members should be alert to worsening depression, suicidal thoughts, or other mood changes during treatment.

Drug Contraindications

If the patient has an allergic reaction to Apremilast or its components, the use of this drug should be avoided. Anaphylaxis can cause severe symptoms such as difficulty breathing, itchy skin, and rashes. It should be used with caution in patients with hepatic impairment. Hepatic insufficiency may increase the risk of drug accumulation in the body, leading to increased adverse reactions. Pregnant and nursing women should avoid use. Patients with depression should use it with caution and patients should be closely monitored for changes in mood while taking Apremilast.

Efficacy

Apremilast has shown significant efficacy in the treatment of psoriasis. According to a systematic review, Apremilast monotherapy was significantly more effective than placebo in achieving PASI-75 (Psoriasis Area and Severity Index score improvement of at least 75%) within 16 weeks in moderate to severe plaque psoriasis, indicating its effectiveness in the management of plaque psoriasis.

The efficacy in treating psoriasis, including scalp and nail lesions, was also significantly better than placebo in clinical trials. Apremilast has definite efficacy, low recurrence rate and good safety. Its clinical data shows that the significant improvement in the severity of psoriasis of nails, scalp, palms and soles (hands and feet) achieved at 16 weeks of treatment was maintained throughout 52 weeks.

Patients should follow their doctor's instructions when using Apremilast and pay attention to the storage conditions and possible adverse reactions of the drug. If a patient experiences adverse reactions while taking Apremilast, it is recommended to speak with a medical professional to see if a dose adjustment or treatment change is needed.