BACKGROUND: In the phase III double-blind Efficacy and Safety Trial Evaluating 
the Effects of Apremilast in Psoriasis (ESTEEM) 1 and 2, apremilast, an oral 
phosphodiesterase 4 inhibitor, demonstrated efficacy in moderate to severe 
psoriasis.
OBJECTIVE: We sought to evaluate efficacy of apremilast in nail/scalp psoriasis 
in ESTEEM 1 and 2.
METHODS: A total of 1255 patients were randomized (2:1) to apremilast 30 mg 
twice daily or placebo. At week 16, placebo patients switched to apremilast 
through week 32, followed by a randomized withdrawal phase to week 52. A priori 
efficacy analyses included patients with nail (target nail Nail Psoriasis 
Severity Index score ≥1) and moderate to very severe scalp (Scalp Physician 
Global Assessment score ≥3) psoriasis at baseline.
RESULTS: At baseline, 66.1% and 64.7% of patients had nail psoriasis; 66.7% and 
65.5% had moderate to very severe scalp psoriasis in ESTEEM 1 and 2. At week 16, 
apremilast produced greater improvements in Nail Psoriasis Severity Index score 
versus placebo; mean percent change: -22.5% versus +6.5% (ESTEEM 1; P < .0001) 
and -29.0% versus -7.1% (ESTEEM 2; P = .0052). At week 16, apremilast produced 
greater NAPSI-50 response (50% reduction from baseline in target nail Nail 
Psoriasis Severity Index score) versus placebo (both studies P < .0001) and 
ScPGA response (Scalp Physician Global Assessment score 0 or 1) versus placebo 
(both studies P < .0001). Improvements were generally maintained over 52 weeks 
in patients with Psoriasis Area and Severity Index response at week 32.
LIMITATIONS: Baseline randomization was not stratified for nail/scalp psoriasis.
CONCLUSION: Apremilast reduces the severity of nail/scalp psoriasis.