Apremilast Use May Delay Initiation of Biologics in Psoriatic Arthritis

Published on: 

Treatment with apremilast was associated with extended time to biologic initiation when compared with treatment with methotrexate.

Patients with psoriatic arthritis (PsA) who are systemic naïvehave a lower rate of, and longer time to, biologic initiation following apremilast (Amgen, Otezla) initiation, compared with those treated with methotrexate, according to a study published in Open Access Rheumatology.1

“These results were consistent in patients with 1 and 2 years of follow-up after apremilast or methotrexate initiation, with differences being observed as early as 3-month post-index,” Michael S Broder, MD, Partnership for Health Analytic Research in Beverly Hills, California, and colleagues, stated.

Apremilast, an oral small molecule phosphodiesterase 4 (PDE4) inhibitor, is approved by the FDA for adult patients with active PsA. Unlike methotrexate and biologics, apremilast does not require frequent laboratory monitoring, potentially making it more convenient to use.The objective of this study was to assess time to biologic initiation after apremilast versus methotrexate treatment in a real-world setting among patients with PsA who were newly initiating apremilast or methotrexate and had not previously been treated with oral small molecule therapies or biologics.

The 1-year retrospective analysis of a US claims database included 2116 systemic-naïve patients with PsA who started treatment with either apremilast (n = 534) or methotrexate (n = 1582) between January 1, 2015 and December 31, 2018. The mean age was similar for apremilast and methotrexate users, at 50.5 and 50.4 years, but the proportion of females was higher for apremilast compared with methotrexate users, at 59.4% and 54.0%. The first prescription date for apremilast or methotrexate was the index date. Patient demographics, clinical characteristics and healthcare use during the year pre-index (baseline) and the year post-index (follow-up), and median time to biologic initiation were reported. For apremilast and methotrexate users, the mean time to biologic initiation among patients who initiated during follow-up was 194.1 and 138.7 days, respectively (P < 0.001).

After adjusting for confounders, the likelihood of biologic initiation was 58% lower (OR, 0.42 [95% CI, 0.32– 0.54]; P < 0.001) with apremilast, with a lower predicted rate of biologic initiation among apremilast users compared with methotrexate users during follow-up (20.0% [95% CI, 16.6– 23.9%] vs 37.5% [95% CI, 35.0– 40.1%]). Further, apremilast users had a lower risk of biologic initiation than methotrexate users (HR, 0.46 [95% CI, 0.37– 0.57]; P < 0.001) during the 1-year follow-up.

“Apremilast use may delay initiation of the next line of treatment in patients with PsA to a greater extent than methotrexate,” investigators concluded.


Husni ME, Chang E, Broder MS, et al.Biologic Initiation Rate in Systemic-Naïve Psoriatic Arthritis Patients Starting Treatment with Apremilast vs Methotrexate: 1-Year Retrospective Analysis of a US Claims DatabaseOpen Access Rheumatol. 2022;14:123-132