Presenting Author:

Swarnalatha Nagiredla

Principal Investigator:

Dennis West, Ph.D.

Department:

Dermatology

Keywords:

Psoriasis, Apremilast, Infection

Location:

Ryan Family Atrium, Robert H. Lurie Medical Research Center

C25 - Clinical

Rate of infection for apremilast versus other biologic agents

Introduction: Apremilast (Ap), a recently marketed, oral phosphodiesterase 4 inhibitor, is indicated for the management of moderate to severe plaque psoriasis. Given that infection is a well-recognized adverse effect of the established, commonly used oral agents acitretin (A), cyclosporine (C), and methotrexate (M), the aim of this study was to retrospectively determine if the rate of infection, including infections of bacterial (B), viral (V), fungal (F), and parasitic (P) etiology, in patients with psoriasis following exposure to Ap was distinguishable from the rate for A, C, and M. Methods: We searched a large, urban, single center electronic medical record data repository to collect data (January 2015 to September 2016) for all patients (ages 18-89 years) who were diagnosed with one or more infections (ICD-9 codes 001-139) following exposure to Ap for treatment of psoriasis. From this same large patient population, infection data was collected for the other systemic oral agents A, C, and M and compared to the Ap data. Results: Of 717 patients with psoriasis who were exposed to Ap, A, C, or M, 20 of 204 (9.8%) patients exposed to Ap, 5 of 77 (6.5%) patients exposed to A, 12 of 68 (17.6%) patients exposed to C, and 29 of 368 (7.9%) patients exposed to M were diagnosed with one or more infections. Of note, none of the other three oral systemic agents had a statistically significant different rate of infection compared to Ap. For the infections diagnosed following exposure to Ap, 4 (20%) were B, 10 (50%) were V, and 6 (30%) were F. Notably, 7 of the 10 patients with viral infection were diagnosed with herpes virus (herpes simplex and varicella zoster), with one of these 7 patients diagnosed with herpes zoster ophthalmicus. For the infections diagnosed following exposure to A, 2 (40%) were B and 3 (60%) were V. For the infections diagnosed following exposure to C, 9 (75%) were V, 2 (16.7%) were F, and 1 (8.3%) was P. For the infections diagnosed following exposure to M, 10 (34.5%) were B, 15 were V (51.7%), 3 (10.3%) were F, and 1 (3.4%) was P. Conclusions: Findings from this large population of patients with psoriasis indicate that, for patients exposed to oral Ap, the rate of subsequent infection (B, V, F, P) is not unexpected and not statistically significantly different from the rate for other oral systemic agents A, C, and M.