Clinical Practice Survey Regarding Management of Apremilast-Related Diarrhoeas’ in Patients with Psoriasis

Background: Psoriasis affects about 2% of population. Apremilast is the first oral phosphodiesterase 4 (PDEA4) inhibitor marketed in Europe in 2013 and available in France since 2016. Even though this medication is considered to be safe, side effects are frequent with diarrhoea being the most common. No official guideline on apremilast-induced diarrhoea management is currently available. In order to offer clear and simple recommendations to manage diarrhoeas caused by apremilast, we reviewed the literature and surveyed the current practices of dermatologists in France.

Methods: We sent via a French network (ResoPso) a questionnaire to hospital and private practice dermatologists.

Results: 19% of the dermatologists offer a symptomatic treatment, 10.2% non-pharmacologic interventions, 64.6% a combination of the two. 6.1% of the dermatologist’s definitively stop apremilast. 74% of the dermatologists prescribe racecadotril as a first-line symptomatic treatment.

Discussion: Diarrhoea due to apremilast affects 15% of patients. The first action to manage diarrhoea is to grade its severity and treat its complications. The first treatment step are dietary and hygienic advice, followed by the prescription of racecadotril. An alternative approach involves the reduction of the dose of apremilast or it’s temporarily discontinuation. After discontinuation and reversal of diarrhoea, the treatment can be restarted with increasing doses.