TOPLINE:

Apremilast showed partial or complete effectiveness in psoriasis occurring after treatment with immune checkpoint inhibitors (ICIs), with limited benefits seen in psoriatic arthritis (PsA) after ICI treatment. More than 75% of patients had preexisting psoriasis or PsA or other diseases and possibly experienced a flare of their condition; 29% of patients discontinued apremilast due to intolerance.

METHODOLOGY:

• Researchers conducted a multicenter observational study across three major US academic medical centers with registries of patients with rheumatic immune-related adverse events to assess the effectiveness and tolerability of apremilast.
• They included patients who had received an ICI for cancer and were treated with apremilast after ICI initiation for any immune-related indication. Those who had taken apremilast before ICI initiation and those with preexisting autoimmune diseases were also included.
• The analysis included 21 patients (mean age, 59 years; 71% men; 90% White) with ICI-psoriasis and/or ICI-PsA; among them, 10 used apremilast solely for ICI-psoriasis, 3 used it for ICI-PsA alone, and 8 used it for both ICI-PsA and ICI-psoriasis.
• Response to apremilast was assessed by determining changes in Common Terminology Criteria for Adverse Events grading, with a complete response being defined as an improvement to grade 0 and a partial response being defined as any improvement to a lower grade.
• Data on variables, including demographics, cancer type and stage, ICI regimen, the time of onset and severity of immune-related adverse events, response and tolerability to apremilast, and follow-up duration, were also collected.

TAKEAWAY:

• Among the 21 patients, 16 had a preexisting autoimmune condition and 5 did not. Four of those without a preexisting condition showed partial improvement with apremilast, but treatment was stopped because of intolerance in three patients and long-term ineffectiveness in one patient.
• Among patients with preexisting disease and no prior apremilast exposure, 100% of patients in the ICI-psoriasis group showed complete or partial response to apremilast, whereas only 57% of those in the ICI-PsA group showed complete or partial response.
• In patients with preexisting disease who experienced flares (n = 13), the median onset of psoriasis and/or PsA flare was 20.4 weeks after starting ICI. This varied by condition, with the ICI-psoriasis group experiencing flares at a median of 39.7 weeks and the ICI-PsA group experiencing them at a median of 4 weeks.
• Overall, 29% of patients discontinued apremilast because of intolerability (diarrhea and nausea). Cancer progression or death occurred in 38% of the cohort at the last follow-up.

IN PRACTICE:

“Unfortunately, these numbers are too small to draw significant conclusions from, but they do suggest a potential benefit for skin efficacy over joint efficacy,” the authors of the study wrote. “[A]premilast remains an attractive therapeutic option, even for ICI-PsA, given that it is not immunosuppressive and therefore not thought to impair cancer responses to ICI,” they added.

SOURCE:

The study was led by Nilasha Ghosh, MD, MS, Hospital for Special Surgery and Weill Cornell Medical College in New York City. It was published online on July 14, 2025, in Arthritis Care & Research.

LIMITATIONS:

The sample size of the study was small. The effectiveness of apremilast was assessed through changes in Common Terminology Criteria for Adverse Events scores documented by the physician, which may have introduced subjectivity.

DISCLOSURES:

This study was supported by grants from the National Center for Research Resources and the Clinical and Translational Science Center. Some authors also reported support from various institutes, foundations, and funds. One author disclosed receiving honoraria/speaker fees and support for meetings, serving on an advisory board, and a pending patent. Another author reported receiving grants and consulting fees from various sources, while a third author reported being a treasurer for a foundation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.