New understanding of the efficacy of apremilast tablets in the treatment of early-stage oligoarticular psoriatic arthritis with body mass index

A study presented at Dermatology Society highlights the efficacy of the oral phosphodiesterase 4 inhibitor apremilast (Apremilast) in the treatment of patients with early-stage oligoarticular psoriatic arthritis (PSA), particularly those with weight-bearing joint involvement. Oligoarticular PsA is characterized by the involvement of relatively few joints. Although the number of joints is limited, it still significantly affects the patient's quality of life. Recognizing that body mass index (BMI) affects disease activity and treatment response, researchers aimed to explore whether the benefits of apremilast apply across different weight categories

The phase 3 FOREMOST study (NCT03747939) enrolled 187 patients with active weight-bearing joint disease at baseline. Participants were assigned to receive apremilast or placebo for 24 weeks, with the option to extend to 48 weeks, during which time all patients could receive active treatment. The researchers conducted subgroup analyzes based on BMI categories: less than 25kg/m2 (normal weight), 25-30kg/m2 (overweight) and 30kg/m2 or higher (obese).

Apremilast showed significant clinical advantage over placebo in all BMI groups. Patients who received the drug had fewer swollen and tender joint counts at week 16. These improvements persisted through 48 weeks of follow-up. At Week 16, patients treated with apremilast had an overall mean reduction in swollen joint count of 1.1 compared to a mean of 0.1 for patients in the placebo group. When divided into BMI categories, patients with a BMI <25 had an average reduction in swelling count of 1.3 at week 16, compared with 1.0 in the placebo group. In the cohort with a BMI of 25 to <30, apremilast-treated patients experienced a mean reduction of 1.3 (compared to 0) at week 16. In the group with a BMI ≥30, patients treated with apremilast decreased by 1 point at week 16, compared with 0 points in the placebo group.

Additionally, patient-reported outcomes highlighted significant improvements in overall daily functioning and well-being. Health Assessment Questionnaire Disability Index scores improved more significantly in patients treated with apremilast, independent of BMI. Fatigue was also significantly reduced, consistent with improved quality of life scores from tools such as the SF-36 survey and PsAID-12. Apremilast maintained its beneficial effects even in patients with higher BMIs.

Data presented in poster support apremilastEfficacy in early-stage oligoarticular psoriasis involving weight-bearing joints, providing clinically meaningful symptom relief regardless of patient's BMI. Clinicians are encouraged to consider individual patient factors, including BMI, when designing comprehensive management strategies aimed at improving joint health and quality of life in patients with PsA.

References:https://www.dermatologytimes.com/view/emerging-insights-into-apremilast-s-efficacy-for-early-oligoarticular-psoriatic-arthritis-across-bmi-spectrums