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In data presented at the Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting in Destin, FL, this week, investigators reported that the PDE4 inhibitor provided patients with psoriasis and/or psoriatic arthritis (PsA) meaningful benefit in weight and HbA1c reduction, as well as psoriatic disease outcomes including Routine Assessment of Patient Index Data 3 (RAPID3) and Physician Global Assessment (PGA) over 6 months.
What’s more, the benefit was observed in patients both with and without diabetes—a common comorbidity among patients with psoriatic disease. The findings add further dimension of benefit for apremilast, which additionally at CCR East 2023 was linked to similar clinical benefits in patients with obesity by the same research team.
The investigators led by Kate Orroth, PhD, senior manager at the Amgen Center for Observational Research, conducted a real-world cohort analysis of US psoriasis and PsA patients who received apremilast over 6 months. The team sought the impact of the drug on patients’ changes in cardiometabolic and disease activity, stratified by diabetes status.
“Patients with psoriasis and PsA have a higher prevalence of cardiometabolic comorbidities like diabetes compared to the general population,” Orroth and colleagues wrote. “Clinical data have shown apremilast may reduce weight and glycated hemoglobin (HbA1c) levels. “
The team analyzed cohort data from the OM1 Real-World Cloud from March 2013 – November 2021 in order to provide an estimation of diabetes burden among psoriasis and PsA patients initiating apremilast for their psoriatic disease for ≥6 months. Patient diabetes status was defined by non-diabetic versus pre-diabetic or type 2 diabetes mellitus (T2DM).
Along with patient demographic and clinical characteristics, investigators reported baseline comorbidities and therapies, post-treatment changes in weight and HbA1c, and RAPID3 and PGA for each treated patient.
The final assessment included 8487 patients with psoriasis and PsA who initiated apremilast. Mean patient age was 55.2 years old; two-thirds (62.8%) were female, and one-fourth (23.6%) had either pre-diabetes or T2DM. Among the diabetic cohort, mean age was older than the non-diabetic cohort (59.0 years vs 54.0 years).
The rate of psoriatic Black patients with diabetes was nearly double that of those without (4.1% vs 2.3%); Hispanic patients were also more prevalent in the diabetes cohort (5.7% vs 3.6%). Another 28.3% of patients in the diabetic cohort had ≥2 comorbidities—the most common being hypertension (65.0%), dyslipidemia (57.0%), and cardiovascular disease (25.1%).
A majority of patients were obese or severely obese (58.8%); baseline mean HbA1c was 6.8%. Three-fourths (75.8%) of patients had psoriasis; two-thirds (68.1%) had PsA, and 44.0% had both.
At 6 months, patients with psoriatic disease and diabetes reported a mean -1.8% reduction in weight, versus -1.5% among patients without diabetes (P = .045). Patients with psoriatic disease and diabetes additionally reported a mean -1.5% reduction in HbA1c at 6 months, versus a mean -4.7% reduction among patients without diabetes.
In psoriatic disease measures, patients with diabetes more greatly improved mean RAPID3 (-11.3%) and PGA (-23.8%) scores at 6 months than patients without diabetes (-6.3% and -17.1%, respectively).
Regardless of diabetes status at baseline, 6-month apremilast was associated with reduced weight, HbA1c and psoriatic disease severity among patients with psoriasis and PsA.
“This real-world study highlights the significant cardiometabolic burden among psoriasis and PsA patients who initiated apremilast,” investigators wrote. “Similar to the clinical trials data, this study suggests apremilast may have beneficial effects on cardiometabolic markers in clinical practice including reductions in weight, HbA1c and improvements in psoriasis and PsA disease outcomes.”