Background/Purpose: Apremilast is a novel oral phosphodiesterase 4 inhibitor that is used for plaque psoriasis (PsO) and psoriatic arthritis (PsA). This medicine is unique in that it is oral and does not require refrigeration or laboratory monitoring. It also does not increase infection risk and has a small side-effect profile in comparison to other agents. These characteristics make apremilast a potentially useful therapy for active duty (AD) military patients who may deploy to austere environments. This retrospective chart review examined the use of apremilast in the Army for PsO and PsA in an effort to describe the effects that it may have on troop deployability.

Methods: Study subjects included AD U.S. Army personnel who were started on apremilast for PsO or PsA between March 31, 2014, and January 1, 2018. A list of candidates was obtained via the defense pharmacy analytics section. In order to be considered for inclusion, prior dermatology or rheumatology documentation needed to be available in the military health record confirming diagnosis of PsO or PsA. Each patient’s records were reviewed to assess the efficacy and tolerability of treatment by listing duration of treatment, any discontinuation of therapy, or documented adverse events. Military records were then examined to confirm current deployability. Primary endpoints consisted of deployments while on apremilast and current deployability. Resulting data points were subsequently organized and reported in a descriptive manner for the purpose of analyzing practice patterns in this patient population.

Results: 227 study subjects were included. The patient population was predominantly male (n=209, 92.1%) with an average age of 38. 165 (72.7%) had PsO, and 62 (27.3%) had PsA. As of the date of initial data extraction (April 3, 2019), 63 (27.8%) were still on apremilast, but the remainder had discontinued the medication. The average duration of treatment was 15.2 months for all patients. When available, the most common reason for discontinuation was lack of efficacy (n=58). The most common reported adverse effect was gastrointestinal upset (n=30). 85 patients with both PsO and PsA had deployments during the study timeframe until April 2019. Of the patients with deployments meeting the above criteria, 22 patients with PsO and 5 with PsA were able to deploy while on apremilast. Of the 129 patients who were still AD at initial data extraction, 119 (92.2%) were reported as “Deployable” on military records.

Conclusion: Further research is needed to determine the impact of apremilast on deployability in the U.S. Army. Despite the limitations arising from record heterogeneity and the descriptive nature of this study, this data does provide insight into caring for patients that cannot be given other agents due to career concerns. In our military experience, the medical separation process is almost invariably started when a patient is given an immunosuppressive medication. In examining this data, providers who take care of AD patients should consider apremilast as an alternative therapeutic option in PsO and PsA for maintaining both disease control and deployability while remaining mindful that a lack of efficacy could be a future concern.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effects-of-apremilast-therapy-on-deployability-in-active-duty-u-s-army-soldiers-with-plaque-psoriasis-and-psoriatic-arthritis/