Real-World Apremilast Use for Treatment of Plaque Psoriasis in Italy: Patient Perspective, Characteristics, and Clinical Outcomes from the DARWIN Study

Abstract

Introduction: While several European studies have reported real-world apremilast use, patient-perceived benefits, and treatment satisfaction, local reimbursement criteria for apremilast vary and data from Italy are limited.

Methods: The cross-sectional DARWIN study enrolled consecutive patients who had initiated apremilast for plaque psoriasis 6 (± 1) months prior to enrolment at a single visit across 24 Italian dermatological sites. Disease severity was assessed using body surface area (BSA) and Physician Global Assessment (PGA). Patient-reported outcomes assessed 6 (± 1) months after apremilast initiation were Dermatology Life Quality Index (DLQI), Patient Benefit Index (PBI), and 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9).

Results: Of 184 patients enrolled between July 2019 and January 2021, 180 were included in the analysis. At apremilast initiation, median (25th-75th percentile) time since psoriasis diagnosis was 8.6 (3.2-22.2) years; median BSA, 10.0% (5.0-16.0); mean (standard seviation, SD) DLQI total score, 13.5 (8.0). Over half (54.9%) of patients with available data reported psoriasis had a very or extremely large effect on their quality of life (QoL); half reported itching (50.6%) and/or special areas involvement (50.0%). Most (73.9%) had comorbidities and were biologic-naïve (81.5%). The most common reasons for initiating apremilast were lack of efficacy of previous treatment (56.7%) and contraindications to other treatments (44.4%). At 6 (± 1) months, most patients were continuing apremilast and/or reported a Global PBI score ≥ 1 (minimum clinical benefit) (86.1% and 90.0%, respectively); approximately half achieved BSA ≤ 3% and/or DLQI total score ≤ 5 (47.1% and 48.5%); 18.8% achieved PGA = 0; mean (SD) TSQM-9 global treatment satisfaction score was 59.0 (24.8). Apremilast was well tolerated; no new safety signals were identified.

Conclusions: Patients treated with apremilast for 6 months in Italian clinical practice reported improved QoL, clinically relevant improvements in symptoms, high treatment satisfaction, and high treatment persistence. Our data indicate apremilast is a valuable treatment option for moderate plaque psoriasis.

Study registration: ClinicalTrials.gov identifier, NCT04031027.

Keywords: Apremilast; Dermatology Life Quality Index; Italian real-world evidence; Patient Benefit Index; Patient perspective; Patient-reported outcomes; Plaque psoriasis; Psoriasis comorbidities; Quality of life; Treatment satisfaction.

Fig. 1

Signs and symptoms of a psoriasis at apremilast initiation and b in special areas (all patients, N = 180)

Fig. 1

Signs and symptoms of a psoriasis at apremilast initiation and b in special areas (all patients, N = 180)

Fig. 2

Psoriasis treatments prior to apremilast initiation (patients with non-missing data, N = 178)

Fig. 3

Clinical reasons for initiating apremilast (all patients, N = 180)

Fig. 4

Mean (SD) DLQI a total score and b subscale scores 6 (± 1) months after apremilast initiation (patients with non-missing data)

Fig. 5

Mean (SD) a TSQM-9 domain scores and b PBI Global score 6 (± 1) months after apremilast initiation (patients with non-missing data)