Apremilast (Otezla(®)) is an oral phosphodiesterase 4 inhibitor indicated for 
the twice-daily treatment of adults with psoriasis and psoriatic arthritis 
(PsA). Its use in these patient populations has been assessed in two phase III 
clinical trial programmes (ESTEEM and PALACE). At 16 weeks in the two ESTEEM 
trials, apremilast reduced the severity and extent of moderate to severe plaque 
psoriasis, including nail, scalp and palmoplantar manifestations, versus placebo 
in adults, with these benefits generally being sustained over 52 weeks of 
treatment. Similarly, in three PALACE trials (PALACE 1-3), apremilast improved 
the signs and symptoms of PsA relative to placebo at 16 weeks in adults with 
active disease despite treatment with conventional synthetic and/or biologic 
disease-modifying anti-rheumatic drugs. These PsA benefits were generally 
sustained for up to 104 weeks of treatment; skin involvement, enthesitis and 
dactylitis also improved with the drug. Apremilast was generally well tolerated, 
with the most common adverse events being diarrhoea and nausea in the first year 
of treatment (usually occurring in the first 2 weeks after the first dose and 
resolving within 4 weeks) and nasopharyngitis and upper respiratory tract 
infection with continued treatment. Although further longer-term and comparative 
efficacy and tolerability data would be beneficial, the current clinical data 
indicate that apremilast is an effective and well tolerated option for the 
management of psoriasis and PsA in adults.