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How long does it take for Otezla to work?

Medically reviewed by Leigh Ann Anderson, PharmD Last updated on Apr 27, 2020.

Official Answer

by Drugs.com

Otezla (apremilast) is FDA-approved to treat plaque psoriasis, psoriatic arthritis, as well as Behçet’s Disease. Patients may start to feel an improvement within the first few weeks of starting treatment, but improvement continues after this time frame. Otezla is meant to be taken long-term for these chronic conditions.

In clinical studies:

  • 32% to 41% of adults with psoriatic arthritis had at least a 20% improvement after 16 weeks (compared to 18% to 19% of the inactive placebo group). 
  • 28.8% to 33.1% of adults with plaque psoriasis saw at least a 75% improvement after 16 weeks (compared to 5.3% to 5.8% of the inactive placebo group). 
  • 52.9% of adults with Behçet’s Disease were free of oral ulcers at 12 weeks (compared to 22.3% in the inactive placebo group). Of this group, 30% of patients taking Otezla were ulcer-free at 6 weeks. Pain relief began as early as 2 weeks

Improvements in physical functioning and ability to perform daily activities (like dressing, walking, eating, grip and personal hygiene) were also improved in patients with psoriatic arthritis. 

Patients were allowed to use additional medications, such as NSAIDS and DMARDS for psoriatic arthritis, or topical creams for psoriasis, to control their symptoms during the studies. However, patients with Behçet’s Disease did not use additional treatments.

Remember, each patient is unique and the results you see with Otezla may not be similar to other patients.

Key facts about Otezla

  • Otezla is a small molecule phosphodiesterase 4 (PDE4) inhibitor approved by the FDA for the treatment of plaque psoriasis, psoriatic arthritis, and oral ulcers associated with Behçet’s Disease.
  • Otezla is taken as an oral tablet twice a day. Your doctor will start your dose slowly to help lessen side effects like stomach upset or diarrhea. If you have severe kidney disease, you will need a lower dose of Otezla.
  • Otezla’s generic name is apremilast, but a generic is not yet available for this drug. Amgen is the manufacturer for Otezla and it was first approved by the FDA in 2014.
  • Otezla works in your immune system by blocking the phosphodiesterase type 4 (PDE4) enzyme in the cell to lower inflammation in the body. The PDE4 enzyme is a type of immune system protein that can be overactive in some people, leading to symptoms.

Otezla side effects you should know about

The most common side effects that can occur with Otezla are diarrhea, nausea and vomiting, upper respiratory tract infections, weight loss, headache, and stomach pain. Over time, many of these side effects will subside. Your doctor will slowly increase your Otezla dose over the first 5 days to lessen side effects. 

In most patients, diarrhea and nausea occurred within the first 2 weeks of treatment and tended to go away over time without stopping Otezla

Most common side effects Otezla (920 people) Placebo (506 people)
Diarrhea 17% of patients 6% of patients
Nausea 17% 7%
Upper respiratory tract infection 9% 6%
Tension headache 8% 4%
Headache 6% 4%

*In plaque psoriasis studies; data from manufacturer.

Severe diarrhea, nausea, and vomiting can occur within the first few weeks of starting Otezla, and in some cases, patients were hospitalized. Older patients may be at a greater risk, especially if they are at risk of low blood pressure or dehydration, or taking medications that can worsen these effects.

If you develop severe diarrhea, nausea or vomiting, tell your doctor immediately. Side effects of severe diarrhea or vomiting typically improve quickly with dose reduction or discontinuation of Otezla. Do not stop taking Otezla unless recommended by your doctor. 

If you notice that you are having signs or symptoms of depression or worsened depression, suicidal thoughts, or other mood changes while taking Otezla, contact your doctor immediately. Your family members should also help to monitor you for these changes. Before starting treatment with Otezla, tell your doctor if you have ever had problems with mood or depression. 

Weight loss can be a significant side effect with Otezla. Your doctor will monitor your body weight regularly, and decide if it is safe for you to remain on Otezla.

In clinical studies, about 4.6% to 6.1% of patients stopped treatment due to any side effect, compared to 1.2% to 4.9% for placebo-treated patients.

Have your pharmacist or doctor review for drug interactions, as some medications may lower the effectiveness of Otezla.

Bottom Line

  • Otezla (apremilast) is a phosphodiesterase 4 (PDE4) inhibitor available as an oral tablet used to treat plaque psoriasis, psoriatic arthritis, and oral ulcers associated with Behçet’s Disease.
  • Otezla can start working in the first few weeks of treatment and patients usually see therapeutic results within 12 to 16 weeks.
  • Your initial dose of Otezla is started gradually to help minimize stomach side effects like diarrhea and nausea.
References
  • Otezla [package insert]. Thousands Oak, CA: Amgen, 2020. https://www.pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/otezla/otezla_pi_english.ashx
  • Otezla.com. Safety and side effects info. Amgen 2020. https://www.otezla.com/safety-and-side-effects

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