Otezla (Apremilast)

Otezla (also referred to by its generic name, apremilast) is a systemic medication that can be used to treat moderate to severe psoriasis and psoriatic arthritis.

How does Otezla work?

It is not known exactly how Otezla works in psoriasis or psoriatic arthritis. However, it is known that Otezla inhibits (ie. stops it from working as it usually does) an enzyme known as phosphodiesterase 4, or PDE4. PDE4 controls the inflammatory action within a cell, which can affect the level of inflammation associated with psoriasis or psoriatic arthritis. Helping to control this inflammation can lead to an improvement in symptoms for people with psoriasis or psoriatic arthritis.

Who is Otezla for?

Otezla is intended for use in adults with moderate to severe chronic plaque psoriasis who have not responded to, or cannot take other systemic treatments including ciclosporin, methotrexate or PUVA for health reasons.

In Scotland, Otezla can also be used alone or in conjunction with another Disease-Modifying Anti-Rheumatic Drug (DMARD), for example methotrexate, sulfasalazine or leflunamide, in adults with active psoriatic arthritis, who have not had an acceptable response to another DMARD, or who cannot take another DMARD for health reasons.

In England and Wales, Otezla can be used alone or in combination with other DMARDs in adults with active psoriatic arthritis who:

  • Have peripheral arthritis (ie. the joints of the arms and legs are affected) with three or more swollen joints and three or more tender joints
  • Have not had an acceptable response to at least two other DMARDs

How is Otezla used?

Otezla is taken orally in tablet form twice a day. The dose is gradually increased over the first five days, until the patient is taking the full 30mg twice a day from day six onwards.

Otezla can be taken on its own, or with methotrexate.

Who should not take Otezla?

  • People who are lactose intolerant, or who have conditions that mean they have difficulty absorbing certain sugars, should not take Otezla
  • Pregnant or breastfeeding women should not be treated with Otezla and women should not fall pregnant whilst taking Otezla
  • Caution should be taken in people with severe kidney impairment, and the dose should be reduced
  • Caution should be taken in people who are underweight at the start of treatment, and their weight should be monitored regularly – this is because Otezla can cause weight loss in some cases

What are the side effects of Otezla?

The most common side effects reported were diarrhoea and nausea. These side effects were mostly mild or moderate, and most common in the first two weeks – settling down within four weeks. Other side effects reported commonly include upper respiratory tract infections, cough, vomiting, loss of appetite, headaches and fatigue (feeling tired). Most side effects were considered to be mild or moderate in severity.

In the clinical trials, some people reported experiencing depression. Before starting Otezla, tell your doctor if you have had feelings of depression, suicidal thoughts, suicidal behaviour, or other mood changes. After starting Otezla, tell your doctor if any of these symptoms develop or worsen.

Otezla is a new treatment and, as such, this side effect data comes from clinical trials.


The information on this page is also available in our Otezla (apremilast) information sheet

March 2017 (Review Date: May 2018)

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