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Patients with psoriatic arthritis and/or psoriasis reported improved BMI and HbA1C after 6 months of apremilast—with pronounced benefit among patients with obesity.
The findings from the real-world study would implicate increased benefit of the PDE4 inhibitor generally used to treat inflammatory conditions, as obesity is both persistent in patients with psoriatic disease and a driver of more severe exacerbation and symptoms.
In trial results presented at the Clinical Congress of Rheumatology (CCR) East 2023 Annual Meeting in Destin, FL this week, a team of Amgen investigators led by Kate Orroth, PhD, senior manager at the Amgen Center for Observational Research, observed changes in cardiometabolic and psoriatic disease activity in US patients with obesity newly treated with apremilast over 6t months.
“Obesity prevalence is higher in patients with psoriasis and PsA than the general population,” Orroth and colleagues wrote. “Weight loss may improve psoriasis disease severity in obese patients. Clinical data suggest apremilast may be associated with weight loss and with reductions in glycated hemoglobin (HbA1c) in patients.”
The team conducted their analysis by first using a real-world patient database to estimate the prevalence of obesity among patients with psoriasis and/or PsA diagnoses who were initiating apremilast between March 2013 – November 2021. Patients were stratified based on 3 body mass index (BMI) scores: non-obese, obese (BMI 30 – 34.9) or severely obese (BMI ≥35).
Investigators sought outcomes including changes in weight and HbA1c, as well as psoriatic outcomes including Routine Assessment of Patient Index Data 3 (RAPID3) and Physician Global Assessment (PGA) scores at 6 months.
Patients eligible for assessment remained on apremilast for ≥6 months. The assessment included 8250 patients, of whom 39.6% were not obese, 26.9% were obese and 33.5% were severely obese. Mean BMI was 32.7.
Mean patient age was 55.2 years old; 63.1% were female and 77.6% were White. Just 15.2% of patients reported >1 comorbidity. Three-fourths (75.8%) of patients were diagnosed with psoriasis, two-thirds (64.8%) were diagnosed with PsA; 44.3% of patients were diagnosed with both diseases.
Investigators observed increases in comorbidity prevalence based on increasing obesity status among psoriatic patients; scores reflecting disease severity were generally mild to moderate among patients at baseline.
After a 6-month regimen of apremilast, investigators observed increased improvements in weight by lbs (-1.9% and -1.8%) and HbA1c (-1.9% and -2.3%) among obese and severely obese patients, respectively, versus non-obese patients (-1.5% weight; -1.1% HbA1c).
Severely obese patients reported the most significant mean improvement in RAPID3 scoring at 6 months (-10.0%), followed by non-obese (-6.4%) and obese (-5.5%) patients. Per PGA at 6 months, obese patients reported a -21.5% mean improvement, versus -18.5% among severely obese and -15.2% among non-obese patients.
Though the clinician- and patient-reported outcomes for cardiometabolic and psoriatic disease improvements were more pronounced among patients with obesity and severe obesity, investigators did note that all patients receiving apremilast reported mean improvement from baseline regardless of weight status.
Orroth and colleagues concluded their real-world analysis indicated possible efficacy of apremilast in cardiometabolic outcomes along with disease benefit in patients with psoriatic disease and obesity.
“Improvements in cardiometabolic and disease activity measures observed across BMI categories emphasize the beneficial effects of apremilast in obese as well as non-obese patients,” they wrote.