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TOPLINE:

Apremilast treatment for 1 year significantly reduced abdominal fat and maintained lean mass in patients with psoriatic arthritis (PsA), alongside notable improvements in disease activity. Those with obesity experienced the most substantial fat loss.

METHODOLOGY:

• A longitudinal, nonrandomized, multicenter trial was conducted in the Netherlands to examine the effects of anti-inflammatory treatment with apremilast on abdominal fat measures and cardiovascular risk factors.
• A total of 44 adults with active PsA (mean age, 56 years; median body mass index [BMI], 28), including 30 women, initiated apremilast and were recruited between March 2017 and December 2022, with follow-up for up to 12 months.
• Participants received 30 mg of apremilast twice daily after a titration period, with assessments conducted at baseline, 26 weeks, and 52 weeks.
• The primary outcome was body composition, assessed using dual-energy x-ray absorptiometry, with a focus on fat mass and lean mass.
• Secondary outcomes included disease activity, blood pressure, lipid variables, carotid intima-media thickness, and glucose levels.

TAKEAWAY:

• Only 17 out of 44 patients completed the study, with 27 discontinuing due to drug ineffectiveness or adverse effects.
• After 1 year, apremilast treatment resulted in a significant reduction in outcomes, including a decrease in total body mass by 8.8 kg (P = .008) and total body fat mass by 7.4 kg (P = .005).
• Patients with obesity (BMI ≥ 30) experienced the greatest weight loss (mean reduction, 12.8 kg), with a mean reduction 10.5 kg in total fat mass (P = .03 for total body mass and total fat mass for those with BMI of ≥ 30 vs 18.5-24.9). No significant changes were observed in cardiovascular risk factors such as blood pressure, lipid variables, or glucose levels.
• After 1 year of treatment, a significant decrease in the Disease Activity Score in 28 joints based on C-reactive protein was noted (−0.6; P = .01). Additionally, various fat mass measures were significantly correlated with decreased disease activity, with android fat mass showing the highest correlation (P = .004).

IN PRACTICE:

“The observed reduction in android fat suggests beneficial metabolic effects and vascular function, which may contribute to a lower CV [cardiovascular] risk in these patients. However, given the exploratory nature of this study, further research involving a larger patient population is required,” the authors wrote.

SOURCE:

This study was led by Romy Hansildaar, MD, and Eva H. van Geel, MD, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, the Netherlands. It was published online on April 1, 2025, in The Journal of Rheumatology.

LIMITATIONS:

The small sample size of the study and the high dropout rate limited the generalizability of the findings. Differences in baseline characteristics between patients who completed the study and those who discontinued could have influenced the results. The lack of a control group limited the ability to evaluate the effects of apremilast. Variability in dual-energy x-ray absorptiometry scanners used for body composition assessments may have affected the results.

DISCLOSURES:

This study was supported by Amgen BV, which previously acquired apremilast from Celgene Corp. Two authors reported receiving support from various pharmaceutical companies, such as Janssen and UCB.

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