What to Know About Otezla for Psoriatic Arthritis
Key takeaways:
Otezla (apremilast) is a prescription medication that’s FDA approved to treat psoriatic arthritis (PsA), plaque psoriasis, and Behçet’s disease. It works by reducing the excess inflammation associated with these conditions.
Otezla is an oral tablet that’s typically taken twice daily. It can improve joint pain and swelling, but it can cause side effects such as nausea, diarrhea, and headache. More serious side effects are rare.
There are ways to save on Otezla. If you’re eligible, a manufacturer savings card can help you access Otezla for as little as $0 per month. A patient assistance program is also available.
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Table of contents
Psoriatic arthritis (PsA) is an autoimmune condition that often occurs along with psoriasis. It can cause pain and swelling in your hands, knees, and feet. And while the exact cause of PsA isn’t known, excess inflammation is generally to blame.
The good news is that many medications are available to keep PsA discomfort under wraps. Some are taken by mouth, and others are given as an injection under the skin or into a vein. Otezla (apremilast) is an oral treatment option your healthcare team may recommend.
What is Otezla used for?
Otezla is a prescription medication that was FDA approved in 2014. Approved Otezla uses include moderate-to-severe plaque psoriasis, active PsA, or mouth ulcers associated with Behçet's disease in adults. Children age 6 and older can also take Otezla for plaque psoriasis.
How does Otezla work for psoriatic arthritis?
Otezla is a phosphodiesterase 4 (PDE4) inhibitor. PDE4 is an enzyme (chemical) in your body that seems to regulate inflammation. By blocking PDE4, Otezla can reduce inflammation linked to certain autoimmune conditions. It helps alleviate skin plaques and joint pain associated with psoriasis and PsA.
How do you take Otezla for psoriatic arthritis?
Most people take Otezla by mouth twice a day — once in the morning and once at night. You can take it alone or in combination with another PsA medication, such as methotrexate (Trexall).
When you first start taking Otezla, there’s a recommended titration period. This means your Otezla dosage should slowly go up over the first 6 days until you reach the recommended dosage of 30 mg twice a day. This gradual increase is meant to help lower the risk of Otezla side effects, such as nausea and diarrhea.
If you have kidney problems, you may only need to take Otezla once a day. The initial titration schedule will also be different. Your prescriber will give you directions for taking Otezla if this applies to you.
What are Otezla’s potential side effects?
Like all medications, Otezla can cause some side effects. Some are common and manageable, but serious side effects are also possible. No matter the severity, they’re important to be aware of.
Common Otezla side effects
The most common side effects reported by people taking Otezla for PsA in clinical studies were:
Nausea
Diarrhea
Headache
Living with psoriatic arthritis: Read how one woman helped manage her symptoms through lifestyle changes and human connection.
Biologics for psoriatic arthritis: Learn about the different biologic medications that treat psoriatic arthritis.
Common triggers: From certain medications to foods, lots of things can make psoriasis worse.
For most people, these side effects happened within the first 2 weeks of treatment. They usually got better or went away over time without having to stop the medication.
A common concern is if Otezla can make joint pain worse. Thankfully, this isn’t likely. New or worsening joint pain has only been reported among some people taking Otezla for Behçet's disease. It hasn’t been reported among people taking it for psoriasis or PsA. But if you feel like your joint symptoms are getting worse after starting Otezla, talk to your healthcare team for guidance. They may decide to change your medications to better manage your symptoms.
Serious Otezla side effects
Serious side effects from Otezla are rare, but they can happen. Keep an eye out for:
Severe nausea and vomiting
Severe diarrhea
New or worsening depression, including thoughts of self harm
Unintentional weight loss
If you’re experiencing any symptoms like these, contact your prescriber right away. They can walk you through the next steps to get you feeling better. And once the situation is addressed, they may decide to lower your dose or have you stop taking Otezla.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
Long-term Otzla side effects
A study on the safety of Otezla found that it carries little risk of long-term side effects. The rate of side effects such as cancer risk, heart-related issues, and serious infections were similar between Otezla and placebo. Otezla may also carry a lower risk of long-term side effects than some other PsA treatments. Real-world data also supports the Otezla safety results seen in clinical studies.
Is Otezla effective for psoriatic arthritis?
Yes, Otezla has been proven effective at reducing symptoms of PsA. The bulk of what we know about its effectiveness comes from a couple of different research studies.
In one study, about 1,500 people with active PsA received Otezla or placebo (a pill with no medication in it) after receiving a disease-modifying antirheumatic drug (DMARD) in the past. In this 5-year study, almost 70% of people receiving Otezla had at least a 20% improvement in joint pain and swelling over time. Of these same people, close to 30% of them experienced as much as a 70% improvement.
In another study, over 500 people with active PsA received either Otezla or placebo. Nobody in the study had ever received previous DMARD treatment. Of those who took Otezla, there was an improvement in PsA symptoms and physical function after 16 weeks that lasted for at least 1 year.
How long does it take for Otezla to work?
Otezla can take 4 months or longer to start improving PsA symptoms. Side effects often appear early during treatment then go away over time. So it’s best to practice patience and stick with the medication, even if you don’t notice an improvement at first. Your healthcare team can provide tips for managing side effects at home if needed.
How to save on Otezla
There are ways to save on Otezla, which is only available as a brand-name medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Otezla’s patient assistance program, which offers the medication free of cost.
Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $0 for Otezla using a savings card from the manufacturer.
What are some Otezla alternatives for PsA?
There are many alternatives to Otezla for treating PsA. They generally fall into two categories: traditional (non-biologic) DMARDs and biologic DMARDs. Both types help protect your joints by calming down inflammation.
Depending on your preferences, medical history, and PsA severity, your healthcare team will help you decide which medication(s) may be best for you. You may need to try several different options before you find one that works well for you.
Traditional DMARDs
Traditional non-biologic DMARDs treat mild to moderate forms of PsA. They include:
Methotrexate
Arava (leflunomide)
Azulfidine (sulfasalazine)
Neoral (cyclosporine modified)
These medications are generally used off-label for PsA. But they’re still recommended by health experts in many situations.
Biologic DMARDs
Biologic DMARDs treat more severe forms of PsA. Biologic alternatives to Otezla for PsA include:
Enbrel (etanercept)
Remicade (infliximab)
Humira (adalimumab)
Simponi (golimumab)
Cimzia (certolizumab pegol)
Stelara (ustekinumab)
Skyrizi (risankizumab)
Cosentyx (secukinumab)
Taltz (ixekizumab)
Orencia (abatacept)
Tremfya (guselkumab)
Some biologics also have biosimilars available, which are similar to generic alternatives. These are usually more affordable than the original (reference) biologics. One example is Inflectra (infliximab-dyyb), a biosimilar to Remicade. Humira biosimilars are also available.
Frequently asked questions
No, Otezla isn’t a biologic. Otezla is a small molecule medication made from chemicals. It comes as a tablet taken by mouth. Biologics are more complex than small molecule medications. They’re derived from natural and living sources rather than chemicals, and they’re typically injected or infused into your body. Biologics work by targeting specific immune system pathways to slow down PsA progression.
There isn’t a one-size-fits-all approach to treating PsA. Your prescriber will tailor your treatment to your specific situation. There isn’t a “best” option, since everyone responds to medications differently. In some cases, you may need a combination of different medications for the best results.
The bottom line
Otezla (apremilast) is a prescription medication that treats psoriasis, psoriatic arthritis (PsA), and Behçet’s disease. It works by reducing the inflammation associated with these conditions.
Otezla comes as an oral tablet that’s typically taken twice daily, and it generally starts working within 4 months. Nausea, diarrhea, and headaches are common Otezla side effects. They usually go away on their own as your body gets used to taking Otezla. But if it’s causing bothersome side effects or doesn’t seem to be effective, know that many other PsA treatments are available. Your healthcare team can tell you more about Otezla and other treatments that may be effective for your symptoms.
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References
American College of Rheumatology. (2018). Psoriatic arthritis guideline.
Amgen Inc. (2024). Otezla - apremilast tablet, film coated [package insert].
Arthritis Foundation. (n.d.). DMARDs.
Kavanaugh, A., et al. (2019). Long-term experience with apremilast in patients with psoriatic arthritis: 5-year results from a PALACE 1–3 pooled analysis. Arthritis Research and Therapy.
Langley, A., et al. (2018). Management of common side effects of apremilast. Journal of Cutaneous Medicine and Surgery.
Mease, P. J., et al. (2023). Apremilast long-term safety up to 5 years from 15 pooled randomized, placebo-controlled studies of psoriasis, psoriatic arthritis, and Behçet’s syndrome. American Journal of Clinical Dermatology.
National Eye Institute. (2024). Behçet's disease.
Persson, R., et al. (2022). Safety of apremilast in patients with psoriasis and psoriatic arthritis: Findings from the UK clinical practice research datalink. Drug Safety.
Wells, A. F., et al. (2018). Apremilast monotherapy in DMARD-naive psoriatic arthritis patients: Results of the randomized, placebo-controlled PALACE 4 trial. Rheumatology.
Wells, A. F., et al. (2022). Apremilast monotherapy for long-term treatment of active psoriatic arthritis in DMARD-naïve patients. Rheumatology.
Zerilli, T., et al. (2015). Apremilast (Otezla): A new oral treatment for adults with psoriasis and psoriatic arthritis. Pharmacy and Therapeutics.
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