Following apremilast treatment, people with psoriatic disease experienced weight loss — principally abdominal subcutaneous fat — as well as improvement in disease activity.
That’s according to data recently published in Rheumatology.
The prospective, open-label study assessed adults receiving 30 milligrams of apremilast as part of routine care for psoriasis and/or psoriatic arthritis. In these patients (median age 54.5 years, 63% women, median BMI 33.2 kg/m2), apremilast was associated with a mean weight loss of 2.2 kg (95% CI 1.4-3.0; P<0.001) and a mean BMI decrease of 0.8 kg/m2 (95% CI 0.5-1.2; P<0.001) after 6 months of treatment. Body composition analysis demonstrated a reduction in total abdominal fat [mean decrease 0.52L (95% CI 0.08-0.96), P=0.022], principally subcutaneous adipose tissue [mean decrease 0.37 L (95% CI 0.05-0.68), P= 0.022]. There was no change in adipocyte diameter, hemoglobin A1c, lipid, glucagon-like peptide-1, or vascular function. Psoriatic disease activity improved with apremilast, although this was not correlated with weight change.
Lyn Ferguson, MBChB, a physician-researcher with the Institute of Cardiovascular and Medical Sciences at the University of Glasgow in Scotland, served as the paper’s first author. Here, she discusses key study findings with the Reading Room. The exchange has been edited for length and clarity.
Why is there a need to study weight loss in the psoriatic disease population?
Ferguson: Obesity, type 2 diabetes, and cardiovascular disease are significant comorbidities in people with psoriasis and psoriatic arthritis. Increased BMI has been associated with worsened psoriatic disease activity, while weight loss appears to improve that activity.
Why did your study set out to assess apremilast in this context?
Ferguson: Previous studies suggested that apremilast, an anti-inflammatory medication, may have additional metabolic effects.
The Immune Metabolic Associations in Psoriatic Arthritis study was an exploratory study designed to assess whether apremilast, a phosphodiesterase (PDE)-4 inhibitor, was associated with weight loss and other cardiometabolic benefits in patients with psoriatic disease.
We investigated whether treatment with apremilast was associated with weight loss, including any change in body fat distribution on MRI and adipocyte morphology on subcutaneous fat biopsy, and whether weight loss correlated with improved disease activity.
We also assessed whether there was any improvement in glucose homeostasis, lipid profiles, levels of the incretin hormone glucagon-like peptide-1 (GLP-1), and vascular function with apremilast.
How would you describe the key findings?
Ferguson: Apremilast was associated with a modest weight loss of 2.2 kg and reduction in BMI of 0.8 kg/m2 after 6 months of treatment. Weight loss was principally in abdominal subcutaneous fat, with no significant change in adipocyte size.
There was no change in HbA1c, GLP-1, lipid, or vascular function parameters with apremilast. Improvements in disease activity were independent of weight change, suggesting apremilast likely acts through immunological rather than metabolic effects.
What clinical suggestions might you offer in light of these findings?
Ferguson: Clinicians should be aware that individuals with psoriatic arthritis have an increased risk of metabolically linked comorbidities such as obesity, insulin resistance, type 2 diabetes mellitus, and non-alcoholic fatty liver disease, as well as cardiovascular disease.
Proper management of psoriatic disease should address these realities. Obesity also appears to relate to worse disease activity. Future studies should focus on weight loss interventions in psoriatic disease to help improve disease activity and lessen cardiometabolic comorbidities.
IMPLICATIONS FOR PRACTICE:
- Apremilast led to significant weight loss in people with psoriatic disease.
- Improvements in disease activity were independent of weight change, suggesting apremilast likely acts through immunological rather than metabolic effects.
- Clinicians treating people with psoriatic disease should be aware of obesity, insulin resistance, and similar comorbidities, in addition to cardiovascular disease.
Ferguson did not disclose any relevant financial relationships with industry.