Possibility of combined therapy with an oral phosphodiesterase-4 inhibitor (apremilast) and dihydrofolatereductase inhibitor (methotrexate) in patients with psoriatic arthritis plaque psoriasis

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Abstract


Background: Data on the possible combinations of apremilast with other types of psoriasis therapy is limited.

Description of clinical cases: We present the data on the efficacy and safety of combination therapy of the selective phosphodiesterase 4 inhibitor and dihydrofolatereductase inhibitor (methotrexate) for the treatment of psoriasis and psoriatic arthritis in patients with moderate-to-severe plaque psoriasis and active psoriatic arthritis with lack of efficacy of methotrexate in the anamnesis. The selective phosphodiesterase 4 inhibitor (apremilast) was administered according to the prescription. The severity psoriatic arthritis of was estimated by PASI. The effectiveness of therapy was evaluated at week 14. Due to the lack of effect, methotrexate was added subcutaneously at week 14. The effectiveness of combination therapy was assessed at week 26. In both cases, the significant clinical improvement was reached (patients reached PASI 75 and PASI 90), a decrease of the psoriatic arthritis’ activity according to the DAS28 and DAPSA.

Conclusion: These clinical cases demonstrate the efficacy and safety of combined therapy with methotrexate and apremilast inpatients with active psoriatic arthritis and moderate to severe plaque psoriasis.


Alexey A. Kubanov

State Research Center of Dermatovenereology and Cosmetology

Email: alex@cnikvi.ru
ORCID iD: 0000-0002-7625-0503
SPIN-code: 8771-4990

Russian Federation, 3-6, Korolenko str., Moscow, 107076

MD, Phd, Professor

Olga G. Artamonova

State Research Center of Dermatovenereology and Cosmetology

Author for correspondence.
Email: artamonova_olga@list.ru
ORCID iD: 0000-0003-3778-4745
SPIN-code: 3308-3330

Russian Federation, 3-6, Korolenko str., Moscow, 107076

MD

Arfenya E. Karamova

State Research Center of Dermatovenereology and Cosmetology

Email: karamova@cnikvi.ru
ORCID iD: 0000-0003-3805-8489
SPIN-code: 3604-6491

Russian Federation, 3-6, Korolenko str., Moscow, 107076

MD, PhD

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Supplementary files

Supplementary Files Action
1. Fig. 1. Patient Sh., 31 years old, with a progressive stage of psoriasis before the start of therapy: rashes on the skin of the trunk (A), scalp (B), upper and lower extremities (C) are represented by infiltrated papules and bright pink plaques with a small plate peeling View (302KB) Indexing metadata
2. Fig. 2. Patient Sh., 31 years old, with progressive stage of psoriasis after 14 weeks of monotherapy with apremilast: slight positive dynamics in the form of a decrease in erythema, peeling, infiltration on the skin of the trunk (A), scalp (B) of the upper and lower extremities (C) View (347KB) Indexing metadata
3. Fig. 3. Dynamics of PASI, DAPSA, DAS28 indices on the background of combination therapy with apremilast and methotrexate View (122KB) Indexing metadata
4. Fig. 4. Patient Sh., 31 years old, with progressive stage of psoriasis after 26 weeks of therapy: pronounced positive dynamics on the skin of the trunk (A), scalp (B) of the upper and lower extremities (C) View (296KB) Indexing metadata
5. Fig. 5. Patient S., 25 years old, with a progressive stage of psoriasis before the start of therapy: rashes on the skin of the trunk, upper and lower extremities (A), scalp (B) are represented by bright red papules and plaques with severe infiltration and moderate small plate peeling View (165KB) Indexing metadata
6. Fig. 6. Patient S., 25 years old, with progressive stage of psoriasis after 14 weeks of monotherapy with apremilast: slight positive dynamics in the form of a decrease in infiltration, erythema and peeling on the skin of the trunk, upper and lower extremities (A) and scalp (B) View (199KB) Indexing metadata
7. Fig. 7. Dynamics of PASI, DAS28, DAPSA indices in combination with apremilast and methotrexate View (23KB) Indexing metadata
8. Fig. 8. Patient S., 25 years old, with a progressive stage of psoriasis at the 26th week of therapy: pronounced positive dynamics on the skin of the trunk, upper and lower extremities (A) and scalp (B) View (188KB) Indexing metadata

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