Apremilast as a Potential Targeted Therapy for Metabolic Syndrome in Patients with Psoriasis: An Observational Analysis

Abstract

Psoriasis (PsO) is a chronic inflammatory dermatosis that often presents with erythematous, sharply demarcated lesions. Although psoriasis is primarily a dermatological disease, its immune-mediated pathogenesis produces systemic effects and is closely associated with various comorbid conditions such as cardiovascular disease (CVD), metabolic syndrome (MetS), and diabetes mellitus type II (DMII). Apremilast, an oral phosphodiesterase 4 (PDE-4) inhibitor, has shown promise in treating moderate-to-severe psoriasis and is associated with potential cardiometabolic benefits. In a 12-month prospective observational study involving 137 patients with moderate-to-severe psoriasis, we assessed changes in psoriasis clinimetric scores and metabolic profiles from baseline (T0) to 52 weeks (T1) to evaluate the efficacy of apremilast. After 52 weeks of apremilast treatment, we documented a statistically significant decrease in low-density lipoprotein (LDL) and total cholesterol, triglycerides, and glucose levels. Our findings even suggest a potential synergistic effect among patients treated with apremilast, alongside concomitant statin and/or insulin therapy. Although the results of our study must be validated on a larger scale, the use of apremilast in the treatment of psoriatic patients with cardio-metabolic comorbidities yields promising results.

Keywords: PDE4-inhibitor; apremilast; comorbidities; metabolic syndrome; psoriasis.

Figure 1

Graphical representation of average total cholesterol values before and after apremilast treatment. The graphs show the mean ± SD values. ** p < 0.01. ns, no significance (repeated measures ANOVA test).

Figure 2

Graphical representation of average LDL cholesterol values before and after apremilast treatment for the study population, patients treated with and without statins. The graphs show the mean ± SD values. ** p < 0.01, *** p < 0.001. ns, no significance (repeated measures ANOVA test).

Figure 3

Graphical representation of average HDL cholesterol values before and after apremilast treatment for the study population, patients treated with and without statins. The graphs show the mean ± SD values. ns, no significance (repeated measures ANOVA test).

Figure 4

Graphical representation of average triglycerides values before and after apremilast treatment for the study population, patients treated with and without statins. The graphs show the mean ± SD values. ** p < 0.01, *** p < 0.001. ns, no significance (repeated measures ANOVA test).

Figure 5

Graphical representation of average blood glucose values before and after treatment in diabetic versus non-diabetic patients. The graphs show the mean ± SD values. * p < 0.05. ns, no significance (repeated measures ANOVA test).

Figure 6

Graphical representation of average HbA₁c values before and after treatment in diabetic versus non-diabetic patients. The graphs show the mean ± SD values. ns, no significance (repeated measures ANOVA test).

Figure 7

Distribution of patients with metabolic syndrome, hypercholesterolemia, and hypertriglyceridemia before and after apremilast treatment. The graphs show the number of patients before and after treatment. * p < 0.05, *** p < 0.001 (McNemar’s test).

Figure 8

Variation in T0 and T1 clinimetric indices among patients on apremilast therapy. (A–D) Reduction in the PASI, NAPSI, DLQI, and PAIN VAS indexes was statistically significant. The graphs show the mean ± SD values. *** p < 0.001 (repeated measures ANOVA test).

Figure 9

Clinical evaluation at T0 and after 36 weeks of treatment: (A–C) Clinical examination revealed severe plaque psoriasis in the context of metabolic syndrome. (D–F) Clinical improvement of psoriasis and BMI after 36 weeks of treatment with apremilast.

Figure 10

Variation in ESR and CRP in patients on apremilast therapy from baseline to T1. The graphs show the mean ± SD values. * p < 0.05 (repeated measures ANOVA test).