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Frontiers in immunology
2022;13 1021537.

Efficacy and safety profile of phosphodiesterase 4 inhibitor in the treatment of psoriasis: A systematic review and meta-analysis of randomized controlled trials.

Qin Kang, Jing-Si Chen, Huan Yang
Author Information
  1. Qin Kang: Department of Health Statistics and Information Management, School of Public Health, Chongqing Medical University, Chongqing, China.
  2. Jing-Si Chen: Department of Dermatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
  3. Huan Yang: Department of Dermatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
PMID: 36300119 DOI: 10.3389/fimmu.2022.1021537

Abstract

Background: Systemic therapy is an important treatment for psoriasis. Phosphodiesterase 4 (PDE4) inhibitors are new candidates for psoriasis therapy.
Objectives: To evaluate the efficacy and safety of PDE4 inhibitors in psoriasis.
Method: Randomized clinical trials with PDE4 inhibitors vs placebos in patients with psoriasis were identified from MEDLINE, Embase, Cochrane Controlled Register of Trials, ClinicalTrials.gov, from inception to July 14, 2022. The study was registered in PROSPERO (CRD42022345700).
Results: 18 studies were identified, 9 of which included moderate-to-severe plaque psoriasis, 2 mild-to-moderate plaque psoriasis, and 7 psoriatic arthritis. A total of 6036 patients were included. Only one oral PDE4 inhibitor, apremilast, met the inclusion criteria. Overall, compared with the placebo, apremilast was associated with higher response rates in PASI-75 (RR, 3.22; 95% CI, 2.59-4.01), ScPGA of 0 or 1 (RR, 2.21; 95% CI, 1.69-2.91), PPPGA of 0 or 1 (RR 2.33; 95%CI, 1.16-4.66), and a significant decrease in NPASI (SMD, -0.46; 95% CI, -0.58 to -0.33). There were no significant differences in serious adverse events. Subgroup analyses showed that significantly more patients achieved PASI-75 after 16 weeks of therapy with apremilast of 20 mg bid (RR, 2.82; 95% CI, 2.01-3.95) and 30 mg bid (RR, 4.08; 95% CI, 3.12-5.33). Heterogeneity was not significant across studies.
Conclusion: Apremilast is a safe and effective treatment for plaque psoriasis and psoriatic arthritis, especially for difficult-to-treat sites.
Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier (CRD42022345700).

Keywords

PDE4 inhibitor apremilast meta-analysis psoriasis treatment strategies

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MeSH Term

Humans
Phosphodiesterase 4 Inhibitors
Arthritis, Psoriatic
Cyclic Nucleotide Phosphodiesterases, Type 4
Severity of Illness Index
Randomized Controlled Trials as Topic
Psoriasis

Chemicals

Phosphodiesterase 4 Inhibitors
Cyclic Nucleotide Phosphodiesterases, Type 4
Meta-Analysis Systematic Review Research Support, Non-U.S. Gov't Journal Article
Article has an altmetric score of 2

Word Cloud

Created with Highcharts 10.0.0psoriasis2PDE4RR95%CItreatmentapremilast1therapy4inhibitorspatientsplaqueinhibitor33significant-0safetytrialsidentifiedCRD42022345700studiesincludedpsoriaticarthritisPASI-7530mgbidreviewmeta-analysisBackground:SystemicimportantPhosphodiesterasenewcandidatesObjectives:evaluateefficacyMethod:RandomizedclinicalvsplacebosMEDLINEEmbaseCochraneControlledRegisterTrialsClinicalTrialsgovinceptionJuly142022studyregisteredPROSPEROResults:189moderate-to-severemild-to-moderate7total6036oneoralmetinclusioncriteriaOverallcomparedplaceboassociatedhigherresponserates2259-401ScPGA2169-291PPPGA95%CI16-466decreaseNPASISMD4658differencesseriousadverseeventsSubgroupanalysesshowedsignificantlyachieved16weeks208201-395300812-5HeterogeneityacrossConclusion:Apremilastsafeeffectiveespeciallydifficult-to-treatsitesSystematicregistration:https://wwwcrdyorkacuk/prosperoidentifierEfficacyprofilephosphodiesterasepsoriasis:systematicrandomizedcontrolledstrategies

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