Otezla, known generically as apremilast, is an oral prescription medicine approved by the FDA to treat psoriatic arthritis, moderate to severe plaque psoriasis, and oral ulcers associated with Behçet's disease. It works by blocking phosphodiesterase 4 (PDE4), an enzyme that plays a key role in the body's inflammatory process. By inhibiting PDE4, Otezla reduces inflammation, providing relief from the symptoms of these chronic inflammatory conditions. While Otezla offers numerous benefits, it's crucial to understand its potential side effects, including its impact on weight.
What is Otezla?
Otezla (apremilast) is a medication that inhibits the action of an enzyme called phosphodiesterase 4 (PDE4). PDE4 is an important part of your body’s inflammatory process. When PDE4 doesn’t work, or works much less, your body’s inflammatory response isn’t as powerful. Since psoriasis and psoriatic arthritis are, in large parts, conditions that occur when your body’s inflammatory response is a little too strong or mismanaged, Otezla can help patients attain significant relief from the pain and comfort that these conditions cause.
In 2014, the FDA approved Otezla for the treatment of both active psoriatic arthritis and moderate to severe plaque psoriasis in the USA. This was a big deal, since, at the time, the main methods patients had to control these conditions involved medications called “biologics,” which generally required high-maintenance injection or infusion for administration.
Common Uses of Otezla
Otezla is prescribed to treat the following conditions:
- Plaque psoriasis in adults and certain children (6 years and older weighing at least 20 kg)
- Psoriatic arthritis in adults and certain children
- Mouth sores caused by Behcet disease in adults
How to Take Otezla
Apremilast is a tablet. Dosing begins at 10 mg on the first day with a gradual increase in doses over 5 days. The maximum dose is 30 mg twice a day. Starting at a low dose and gradually increasing, reduces nausea and diarrhea which may occur when starting apremilast. Apremilast can be taken with or without food. Tablets should not be crushed, split, or chewed. Dosing is the same for psoriatic arthritis, plaque psoriasis, and Behçet's disease. It can take can take up to 4 months to see improvement in symptoms with apremilast. It is a chronic medication that will be used continuously as long as it is effective and well tolerated.
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Otezla and Weight Loss: What the Studies Say
While Otezla is not a weight loss drug, weight loss has been observed as a side effect in clinical trials. Approximately 10-12% of patients who took Otezla lost between 5-10% of their weight during clinical trials. In comparison, only 5% of patients given a placebo experienced similar weight loss, indicating a potential association between Otezla and increased weight loss. About 2% of patients treated with Otezla lost more than 10% of their body weight.
A pooled analysis of two large trials, ESTEEM 1 and ESTEEM 2, the average change in weight from the start of the trial to week 16 was -1.51 kg, or -3.33 lb for patients receiving Otezla 30mg twice daily. By week 52, approximately 19% of patients had lost more than 5% of their starting weight.
Potential Causes of Weight Loss with Otezla
The exact mechanism for weight loss with Otezla has not been definitively determined, but several factors may contribute:
- Decreased Appetite: Otezla can decrease appetite, which may lead to reduced food intake and subsequent weight loss.
- Digestive Side Effects: Common side effects of Otezla, such as nausea, vomiting, and diarrhea, can also contribute to weight loss. These side effects can be severe in some cases, leading to dehydration and decreased nutrient absorption.
- Phosphodiesterase (PDE4) Inhibition: The PDE4 inhibitory activity of Otezla may play a role in weight loss, although the specific mechanisms are still being investigated.
- Mood Changes: Mood changes, including anxiety and depression, associated with Otezla may affect a patient’s interest in eating and, therefore, their body weight.
Monitoring Weight Loss During Otezla Treatment
Doctors typically recommend monitoring a patient's weight while taking Otezla. Unexpected or significant weight loss should be reported to the doctor. If weight loss is due to digestive side effects or decreased appetite, the doctor may recommend treatment options to manage these side effects. In some cases, stopping Otezla treatment and switching to a different medication may be necessary.
Managing Weight Loss: Practical Steps
Realizing that you’re rapidly losing weight while taking Otezla can be stressful. If you’ve noticed that your clothes are roomier or that the scale seems to be trending downward, consider taking these steps to promote healthy weight management.
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First things first: Take a quick scan of your diet. Have you been eating enough food, and has your diet been varied or full of nutrient-dense foods? If not, it’s likely time to pick up some nuts, lean proteins, and avocados to make sure you can maintain your weight. It may also be worth increasing your protein intake, which can help you preserve muscle mass, or even speak to a dietitian to give you personalized advice based on your unique nutritional needs. Your healthcare team can help you find a professional who can help you thrive!
Prioritizing your regular health check-ups and making sure you get your bloodwork done on time can also help you stay ahead of any unhelpful or too-fast weight loss. Don’t view these appointments as formalities or frustrations-instead, take advantage of them, as key touchpoints to help you get the most out of your treatment.
Other Common Side Effects of Otezla
Besides weight loss, Otezla can cause other side effects, which can be categorized as mild or serious.
Mild Side Effects
Mild side effects that have been reported with Otezla include:
- Decreased appetite
- Back pain
- Heartburn
- Abdominal pain
- Infection, such as respiratory infection
- Fatigue
- Insomnia
- Mild nausea, vomiting, or diarrhea
- Headache
- Joint pain
These side effects are usually temporary and may resolve within a few days to weeks. If they persist, bother you, or become severe, it’s important to consult with your doctor or pharmacist.
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Serious Side Effects
Though less common, serious side effects can occur with Otezla, including:
- Severe nausea, vomiting, or diarrhea
- Depression
- Suicidal thoughts
If you develop serious side effects while taking Otezla, contact your doctor immediately. If the side effects seem life-threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.
Managing Common Side Effects
- Nausea, Vomiting, and Diarrhea: Taking medication with food may help decrease nausea. Otezla can be taken with or without food. If symptoms become severe, your doctor may recommend decreasing your dose of Otezla or pausing or stopping your treatment completely. Sometimes, taking a medication with food may help decrease nausea. Otezla can be taken with or without food. So your doctor may recommend taking the drug with a meal or snack.
- Headache: Your doctor may recommend taking acetaminophen (Tylenol) to help relieve pain.
- Depression: They may recommend treatment for your depression, such as talk therapy or antidepressant medication. They may also recommend pausing or stopping Otezla treatment.
Otezla and Sun Sensitivity
Sun sensitivity was not reported in clinical trials of Otezla. So you should not experience sun sensitivity during your treatment. Other drugs that may be used to treat your condition may cause sun sensitivity. For example, methotrexate (Trexall) may cause sun sensitivity as a side effect. Similar to Otezla, methotrexate can be used to treat plaque psoriasis or PsA. If you have concerns about sun sensitivity during Otezla treatment, talk with your doctor or pharmacist.
Alternatives to Otezla
Otezla may be a more cost-effective and convenient option, depending on your needs and where you get it.
- Biologic medications. Biologic medications are drugs that are derived from living cells. These medications can target specific parts of the immune system, and are often used to treat diseases like arthritis, psoriasis, and Crohn’s disease. Options may include Enbrel, Humira, and Stelara-but it’s always necessary to start these medication discussions with your doctor, first, before you make any decisions. Biologics are effective, but they do require specific care and administration protocols (often, injections).
- DMARDs, or traditional disease-modifying antirheumatic drugs. These drugs don’t tend to cause weight loss but are effective for psoriasis and arthritis. Methotrexate and sulfasalazine are common examples. If you and your doctor opt for this type of medication, watch out for side effects such as bone marrow suppression and liver toxicity.
- An anti-inflammatory diet (insofar as it’s available to you). As Dr. Brynna Connor, M.D., a board-certified family medicine physician who specializes in regenerative medicine, says: “Whether you’re trying to improve current joint conditions or protect against future problems, following a healthy diet can keep you on track.
- Moving your body on a regular basis. You don’t have to become a marathon runner, but just incorporating some version of physical activity regularly into your life can reduce stiffness and improve your joint function.
- Finding a way that works for you to manage your stress. We often underestimate the power that stress can have in our lives. Figuring out an effective method to keep it in check can be one of the best ways to increase your quality of life.
Important Considerations Before Taking Otezla
Before taking Otezla, discuss your health history with your doctor. Otezla may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:
- Alcohol consumption
- Kidney problems
- Depression or mood changes
- Conditions associated with weight loss, such as hyperthyroidism or inflammatory bowel disease (IBD)
- Previous allergic reaction to Otezla
- Pregnancy
- Breastfeeding