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Apremilast Tx for psoriasis reduces fat

Photo by: Huwciwe 2816 via Wikimedia Commons

Treatment with apremilast appears to be associated with fat loss in patients with psoriasis, according to new study results.

The findings come from a study published in JAMA Dermatology that was conducted to determine the association between apremilast treatment for psoriasis and aortic vascular inflammation, cardiometabolic markers and abdominal fat composition.

The single-arm, open-label was conducted between April 11, 2017, and Aug. 17, 2021, at seven dermatology sites in the United States. A total of 101 patients with moderate to severe psoriasis were screened, and 70 were enrolled. Of those enrolled, 60 were retained to week 16, and 39 completed week 52. All participants were treated with 30 mg of apremilast twice daily.

“The study’s most provocative findings are that the drug decreased subcutaneous and visceral fat,” said first study author Joel M. Gelfand, MD, MSCE, in a press release.

Dr. Gelfand is Vice Chair of Clinical Research and Medical Director of the Penn Medicine Dermatology Clinical Studies Unit in Philadelphia, director of the Psoriasis and Phototherapy Treatment Center, and the James J. Leyden, M.D. Endowed Professor in Clinical Investigation in the Department of Dermatology.

“We’re trying to untangle cardiovascular disease for this population so they can achieve better outcomes in the skin and joints, and live longer, healthier lives. This study was a proof-of-principle to better understand the impact apremilast would have on vascular disease.”

While the researchers observed no meaningful changes in aortic inflammation, they noted that apremilast treatment generated “variable but generally beneficial” decreases in certain biomarkers that impact cardiovascular health.

The most notable change was an average 5% to 6% reduction in subcutaneous and visceral fat observed approximately four months into treatment and persisted during treatment and through the end of the study at the one-year mark.

“Visceral fat, or fat that wraps around the abdominal organs, is of special interest because it is particularly dangerous from a cardiovascular standpoint,” Dr. Gelfand said. “It leads to problems like metabolic syndrome, cardiovascular disease, and other issues, so seeing a drop in visceral fat during apremilast treatment suggests that, over the longer term, psoriasis patients who take apremilast may be on a trajectory toward better cardiovascular health.”

In the study, Dr. Gelfand and his colleagues call for more investigation into the effects of apremilast in a cardiovascular context, including larger, placebo-controlled trials that focus on specific cardiovascular events.

He also called for physicians to be on watch for cardiovascular disease in patients with psoriasis.

“Despite known associations between psoriasis and cardiovascular disease, these patients are less likely to get adequately screened,” Dr. Gelfand said. “And when they have risk factors identified, those factors are less likely to be adequately managed compared to their peers without psoriasis. If we can close that gap, we’ll likely be able to help individuals with psoriasis live longer and healthier lives.”


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