Phosphodiesterase-4 inhibitors for psoriasis

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A systematic review of clinical outcomes and safety profiles of Phosphodiesterase-4 (PDE4) inhibitors in managing psoriasis and psoriatic arthritis.

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Background:
Phosphodiesterase-4 (PDE4) inhibitors exert therapeutic effects by blocking intracellular signal transduction pathways. Recently, their use in the treatment of psoriasis (PSO) has shown promising results in several clinical trials. However, methodological data on their safety and efficacy are limited.

Methods:
A search for randomized controlled trials (RCTs) involving PDE4 inhibitors in PSO and psoriatic arthritis (PsA) was conducted using pub med, Embase, and Cochrane Library databases from January 2012 to October 2023. For PSO and PsA, the Psoriasis Area and Severity Index (PASI) 75 and the American College of Rheumatology (ACR) 20 were set as the primary efficacy endpoints. Adverse events (AEs) were categorized based on eight human body systems.

Results:
A comprehensive analysis of 28 RCTs involving 6825 patients who were orally or topically administered PDE4 was performed. Those who were administered 30 mg apremilast twice daily demonstrated boosted response rates for ACR 20 and PASI 75. To a lesser extent, enhanced response rates for PASI 75 and ACR 20 were observed in patients who received 20 mg apremilast twice daily. Adverse effects were predominantly minor and included diarrhea, nausea, and headache.

Conclusions:
The analysis concluded that the efficacy of PDE4 in treating PSO and PsA was superior to that of the placebo, particularly with apremilast at a dosage of 30 mg taken twice daily. The adverse reactions were mild.

Source: onlinelibrary.wiley.com

*Funding: Shanghai Municipal Health Commission, CACM Eaglet Program, Shanghai Oriental Talent Program, China Academy of Chinese Medical Sciences, Shanghai Hospital Development Center, National Key Research and Development Program of China, National Natural Science Foundation of China.