Recent data suggest that combining small-molecule drugs and biologic therapies may be advantageous compared with biologics alone in patients with psoriasis. Researchers performed a meta-analysis to evaluate the combination therapy and found that apremilast could be an effective and safe addition to biologics. Their findings were published in the American Journal of Clinical Dermatology.

The final analysis included 19 retrospective studies published between 2015 and 2020 on the Medline, Embase, Web of Science, and Cochrane Library databases. Of the 19 studies, 9 referred to case reports, 8 referred to case series, and 2 referred to cohort studies. Observation periods ranged from 3 weeks to 24 months

Researchers identified 172 patients with psoriasis who were receiving concomitant treatment with apremilast and a specified biologic agent from among the pooled participants. The majority of patients had plaque psoriasis clinical subtype (n = 164), though 7 had palmoplantar pustulosis and 1 had acute pustular psoriasis.

Apremilast and biologic combination therapy was deemed safe in all studies. Adverse events (AEs) were primarily mild and gastrointestinal-related. Hospitalization due to weight loss was the only serious AE reported. However, the authors did note that AEs were insufficiently reported in several records, and AEs with apremilast monotherapy and combination therapy were comparable. Of the 172 patients, 2 discontinued therapy after lack of response.

Based on limitations of the available data on apremilast and biologic combination therapy in psoriasis, the authors called for more thorough clinical studies but found that combination therapy may be advantageous for some patients.

Reference: Gyldenløve M, Alinaghi F, Zachariae C, Skov L, Egeberg A. Combination Therapy with Apremilast and Biologics for Psoriasis: A Systematic Review [published online ahead of print, 2022 Jun 23]. Am J Clin Dermatol. 2022;10.1007/s40257-022-00703-1. doi:10.1007/s40257-022-00703-1