Apremilast for treating moderate to severe plaque psoriasis

Description of the technology

Apremilast (Otezla, Celgene) is a small-molecule inhibitor of phosphodiesterase 4 (PDE4). Apremilast down-regulates the inflammatory response by modulating the expression of cytokines and mediators associated with psoriasis (including tumour necrosis factor [TNF]‑alpha and interleukin [IL]‑23).

Marketing authorisation

'For the treatment of moderate to severe chronic plaque psoriasis in adult patients who failed to respond to or who have a contraindication to, or are intolerant to other systemic therapy including ciclosporin, methotrexate or psoralen and ultraviolet‑A light (PUVA)'.

Recommended dose and schedule

The recommended dosage is 30 mg twice daily after an initial titration schedule. A single 10 mg dose is given on the first day of treatment; this is titrated to 30 mg twice daily over 5 days (see the summary of product characteristics for the dose titration schedule).

Price

The price of apremilast is £550.00 for a 28‑day pack (56×30 mg tablets) (excluding VAT; British National Formulary online, accessed July 2016).

The company has agreed a patient access scheme with the Department of Health. This scheme provides a simple discount to the list price of apremilast, with the discount applied at the point of purchase or invoice. The level of the discount is commercial in confidence. The Department of Health considered that this patient access scheme does not constitute an excessive administrative burden on the NHS.