PDE4 inhibitors in psoriasis therapy: current insights and future directions

Abstract

The chronic autoimmune disease known as psoriasis creates major life-quality problems for affected patients. The disease evolves through genetic and environmental triggers that trigger continuous keratinocyte multiplication with persistent inflammation. Research into psoriasis treatment now emphasizes phosphodiesterase-4 (PDE4) inhibitors because they manage cyclic adenosine monophosphate (cAMP) signaling to reduce inflammatory cytokine production. This review examines the PDE4 inhibitor potential for psoriasis treatment through investigation of their therapeutic functions alongside their mechanism of action and clinical response, safety data, and novel treatment approaches. The review gathered detailed information about clinical research and pharmaceutical operations of PDE4 inhibitors, specifically for apremilast, roflumilast, and crisaborole. This review also analyzes experimental PDE4 inhibitors alongside the advantages that appear when combining these drugs with biologics or phototherapy, together with methotrexate. The administration of PDE4 inhibitors creates higher intracellular cAMP levels that decrease TNF-α and IL-17 production as pro-inflammatory cytokines. The research on Apremilast, as the most prominent oral PDE4 inhibitor, shows that it both improves PASI scores and maintains good safety results. These medications treat psoriasis symptoms specifically through creams and gels, thus reducing the risk of whole-body side effects. The combined administration of PDE4 inhibitors and biologics leads to better therapeutic effects, which may lower both drug resistance rates and side effects. PDE4 inhibitors function as a valuable alternative therapeutic approach to both standard immunosuppressants and biologic medications in psoriasis treatment. New drug dosage methods connected to personalized treatment plans have the potential to raise patient care effectiveness. Researchers need to study ways to improve PDE4 inhibitor formulations, along with developing new combination therapy approaches to enhance sustained psoriasis disease treatment.

Keywords: Apremilast; Crisaborole; PDE4 inhibitor; Psoriasis; Roflumilast.