Otezla: What You Need to Know About the New Pill for Psoriasis and Psoriatic Arthritis

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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The last few years have brought new treatments for the chronic skin condition psoriasis, and the inflammatory arthritis that may come along with it. Psoriasis can begin at any age, but there are two peaks for age of onset: one between 30 and 39 years and another between the ages of 50 and 69 years. Now there is a new pill that treats both the skin lesions and the arthritis: Otezla (apremilast). Taken twice a day it works, and works well. Here are ten things to know about Otezla.

  1. Otezla works for both for the skin lesions from psoriasis and the arthritis associated with it (psoriatic arthritis).
  1. How does it work? Otezla is a new type of medication called a phosphodiesterase 4 inhibitor. By inhibiting phosphodiesterase 4, we can reduce cytokines and halt the inflammatory response that causes psoriasis and psoriatic arthritis.
  1. Otezla has FDA approval for people with moderate to severe plaque psoriasis and those with psoriatic arthritis.
  1. Does it work for the skin lesions from psoriasis? Yes. In trials done over 4 months, patients had 75 percent improvement in the severity of their skin lesions.
  1. How do I take it? Otezla is a pill you take twice a day, starting low and increasing your dose over a week to limit side effects. Typical doses are a 20 mg tablet or a 30 mg tablet, twice a day.
  1. What are the common side effects? The most common one is a short-term risk of diarrhea, especially in the beginning. Side effects are less if you start slow in the first week.
  1. Does it work for the arthritis that occurs with psoriasis (psoriatic arthritis)? Yes. Patients taking 20 or 30 mg twice a week had significantly less joint pain than those taking a placebo.
  1. Is it better than other psoriasis treatments? We don’t know. Otezla is being studied now against etanercept (Enbrel) once weekly injection. Stay tuned.
  1. What are the upsides of Otezla? It’s a pill rather than an injection or topical ointment. Also, weight loss of 5% – 10% was seen in 12% of patients treated with Otezla.
  1. Is it expensive? Yes, but many insurance companies are covering it. You can only get Otezla at certain specialty pharmacies but without insurance it’s about $2000 per month.

Dr O.

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