AB0781 OPTIMIZATION OF APREMILAST USE IN DAILY PRACTICE BY EXPECTATION MANAGEMENT

Background: Apremilast is an oral phosphodiesterase 4 inhibitor and approved drug for treatment of Psoriatic Arthritis(PsA). Previous studies show apremilast to be efficacious and safe. (1) However, physician are sometimes reluctant to prescribe apremilast in clinical practice due to its perceived side effects, and relatively small effect size (1). Objectives: In this study we investigated the occurrence and frequencies of adverse events, and the effects of patient expectation management on drug survival for PsA patient starting apremilast. Methods: From March 2017 to December 2019, 21 consecutive patients have been included in the apremilast PsA cohort at Reade in Amsterdam, the Netherlands. The initial high dropout rate that was observed with usual care led to a revision in the baseline visit with more emphasis placed on patient expectation management. Results: From the usual care group (UCG; n=12), 10 patients (83%) stopped apremilast within the first year: 6 (50%) due to adverse events, 4 (33%) due to inefficacy. Only 2 patients (17%) completed one year of follow-up. In contrast, in the expectation management group (EMG; n=9), only 1 patient (11%) dropped out due to adverse events, and none stopped due to inefficacy. 2 patients (22%) completed one year of follow-up, the other 6 patients (67%) are within the first year of treatment (median 5 months, range 1-10; figure 1). In total 55 adverse event were reported during the study, of which 40% were gastro-intestinal (table 1). There was one serious adverse event (within in the EMG group, stroke leading to hospitalization) which was considered not related to apremilast, and the patient remained on drug. Conclusion: The most common adverse event for apremilast are gastrointestinal side effects that subsided during prolonged use. Managing patient expectations before start of apremilast increases drug survival and is helpful for optimizing apremilast use in daily practice. References: [1]Kavanaugh A, Mease PJ, Gomez-Reino JJ, Adebajo AO, Wollenhaupt J, Gladman DD, et al. Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann Rheum Dis. 2014;73(6):1020-6. Disclosure of Interests: Romy Hansildaar: None declared, Annelies Blanken: None declared, Maaike Heslinga: None declared, Arno Van Kuijk: None declared, Michael Nurmohamed Grant/research support from: Not related to this research, Consultant of: Not related to this research, Speakers bureau: Not related to this research