Thursday, August 22, 2013

Apremilast in Ankylosing Spondylitis

I had been interested in apremilast in psoriatic and rheumatoid athritis. Now, there’s a new development: apremilast is tested for treatment of ankylosing spondylitis. Apremilast is an oral phosphodiesterase 4 inhibitor (PDE-4), which modulates inflammatory mediators.
E. Pathan and colleagues “just” published a study with the title: “Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in ankylosing spondylitis”. They concluded: “Although a small pilot study, these results suggest that apremilast may be effective and well tolerated in AS and modulates biomarkers of bone biology. These data support further research of apremilast in axial inflammation.” But if you look at the result part, you get disenchanted: “Although the primary end-point (change in BASDAI at week 12) was not met, apremilast was associated with numerically greater improvement from baseline for all clinical assessments compared with placebo with mean change in BASDAI (-1.59±1.48 vs -0.77±1.47), BASFI (-1.74±1.91 vs -0.28±1.61) and BASMI (-0.51±1.02 vs -0.21±0.67); however, differences did not achieve statistical significance.” CRP didn’t change, no difference between verum and placebo groups. The data might also suggest stopping further testing.
The authors argue to conduct a suitably powered study, because of the “current lack of effective oral DMARDs in AS”.
I’m happy that I don’t have to decide as I’m sceptical about apremilast in treating ankylosing spondylitis. Maybe apremilast will be useful against psoriatic arthritis, so it won’t be the last we hear on apremilast, but that’s another story.


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