Navigating Psoriatic Arthritis With Otezla: What You Need to Know

Medically Reviewed by Goldina I. Erowele, MBA, PharmD on July 17, 2024
8 min read

Otezla (apremilast) is an oral tablet commonly used to treat psoriatic arthritis in adults. Psoriatic arthritis is a long-lasting condition that affects the joints in people with psoriasis. Common symptoms of psoriatic arthritis include joint pain, swelling, and stiffness. 

The FDA first approved Otezla for psoriatic arthritis in 2014. The FDA later approved Otezla to treat plaque psoriasis and mouth ulcers from Behçet’s disease. Otezla may also be used for other conditions as determined by your health care provider.

Otezla contains the active ingredient apremilast. It belongs to a class of medicines called phosphodiesterase-4 (PDE-4) inhibitors. While Otezla helps manage the symptoms of psoriatic arthritis, it does not cure the condition.

Below are common questions and answers about Otezla for psoriatic arthritis and whether it may be a treatment option for you.

Otezla may be a treatment option for you if you are an adult with active psoriatic arthritis. Active means that the condition causes you to have symptoms, such as swollen joints. 

A health care provider can help determine if Otezla may be right for you.

Otezla is thought to manage psoriatic arthritis by reducing inflammation in the body. Psoriatic arthritis is a condition in which the immune system attacks the joints and causes inflammation. The following symptoms may occur in the fingers, toes, knees, or other areas. 

  • Swelling
  • Pain or tenderness
  • Stiffness

Otezla is a PDE-4 inhibitor. It works by blocking a protein called phosphodiesterase-4 (PDE-4). This increases a substance in your body called cyclic adenosine monophosphate (cAMP). The increase in cAMP signals your immune system to stop releasing substances that promote inflammation. It also signals your body to release more substances with anti-inflammatory effects.

By reducing inflammation in your body, Otezla is used to reduce or stop the symptoms of psoriatic arthritis and make you more able to be physically active.

The FDA approved Otezla for psoriatic arthritis based on a set of three studies that showed how safe the drug was and how well it worked. These studies were called PALACE 1, 2, and 3.

These studies included nearly 1,500 adults with active psoriatic arthritis. People in the studies had the following traits:

  • Everyone had at least three swollen joints and three tender joints, despite past or ongoing treatment with disease-modifying antirheumatic drugs (DMARDs). 
  • Everyone had psoriatic arthritis for at least 6 months before joining the study.
  • Some people in the study had tried a biologic medicine in the past, such as a TNF blocker.
  • People in the PALACE-3 study had at least one psoriasis skin lesion. 

Everyone was randomly assigned to take either Otezla or a placebo (a fake treatment that contains no medicine). But no one knew if the pill they were taking was the medicine or placebo. During the studies, people were also allowed to take certain other medicines: leflunomide, methotrexate, sulfasalazine, low-dose oral steroids, and/or nonsteroidal anti-inflammatory drugs (NSAIDs). 

In all three studies, the effect of Otezla was measured by finding the percentage of people who had a response. A response was defined as having at least a 20% reduction in symptoms, known as an ACR20 response. ACR scores are commonly used in studies to measure how well medications treat psoriatic arthritis. (ACR stands for American College of Rheumatology.) The following signs and symptoms are considered in this measurement.

  • Number of swollen joints
  • Number of tender joints
  • Pain and symptom severity, as reported by patients
  • Disease severity, as assessed by health care providers
  • Ability to perform daily activities, such as bathing and walking
  • Blood level of C-reactive protein, which is a sign of inflammation

After 4 months, people taking Otezla had a greater reduction in psoriatic arthritis symptoms than people taking a placebo. The table below summarizes the percentages of people who had at least a 20% reduction in symptoms in each study.

Percentage of people with 20% or greater reduction in symptoms of psoriatic arthritis at week 16

 PlaceboOtezla (apremilast)
PALACE 1 Study19%38%
PALACE 2 Study19%32%
PALACE 3 Study18%41%

After 4 months of treatment, some people taking Otezla had an even greater reduction in symptoms. Across the three studies, up to 16% of people taking Otezla had 50% fewer symptoms. And up to 4% of people taking Otezla had 70% fewer symptoms.

People taking Otezla also reported being more physically active and able to carry out daily activities than people taking a placebo. After 4 months, 38% of patients on Otezla had significant improvement in their physical abilities, compared to 27% on a placebo. 

Your results may differ from what was seen in clinical studies.

A yearlong study called PALACE 4 looked at the effect of Otezla as monotherapy for adults with psoriatic arthritis. Monotherapy means you take the medicine by itself, without other arthritis medicines. 

On average, people had been living with psoriatic arthritis for 3.4 years before they joined this study. None of them took DMARDs – not during the study and not ever in the past.

The results showed that Otezla was an effective treatment by itself for reducing the symptoms of psoriatic arthritis. This study suggests that Otezla may be a treatment option for people with psoriatic arthritis, even if they have not already tried DMARD medicines.

One study looked at the safety and effectiveness of Otezla in people with psoriatic arthritis who took this medicine for up to 5 years. 

The side effects reported in this long-term study were similar to the side effects seen in shorter studies. The most common side effects were diarrhea, nausea, and headache, but they were short-term side effects. Diarrhea and nausea mainly happened during the first 2 weeks of Otezla treatment and usually went away within 4 weeks.

This study showed that Otezla was effective for reducing psoriatic arthritis symptoms for up to 5 years. The medicine maintains its effect over time, as long as you continue taking it as prescribed. 

Do not stop taking Otezla unless your health care provider recommends it.

Otezla comes as an oral tablet that you swallow whole. You can take it with or without food. Otezla is available in three strengths: 10 milligrams (mg), 20 mg, and 30 mg. 

The typical dosage for psoriatic arthritis is 30 mg twice daily. Your health care provider may recommend a lower dosage if you have kidney disease.

When you first start Otezla, your health care provider will likely have you follow a titration schedule. This gradually increases your dosage over the first 5 days of treatment and helps to lessen the digestive side effects from Otezla.

The recommended titration schedule of Otezla for psoriatic arthritis is shown below.

Otezla Titration Schedule

Day 110 mg in the morning
Day 210 mg in the morning and 10 mg in the evening
Day 310 mg in the morning and 20 mg in the evening
Day 420 mg in the morning and 20 mg in the evening
Day 520 mg in the morning and 30 mg in the evening
Day 6 and on30 mg in the morning and 30 mg in the evening

It may take 4 months to see the full effects of Otezla for psoriatic arthritis. You can tell the medicine is working if you have less swelling and pain in your joints. If you feel that Otezla is not working after 4 months, contact your health care provider for advice. 

The most common side effects of Otezla in people with psoriatic arthritis include the following.

  • Diarrhea
  • Nausea
  • Headache

If you get severe diarrhea, nausea, or vomiting while taking Otezla, contact your health care provider. They will recommend ways to manage these side effects. In some cases, they may lower your dosage. 

You can try to prevent headaches by getting enough sleep and drinking plenty of water while taking Otezla. Diet changes may also help. You may be able to treat headache pain with an over-the-counter pain reliever, such as acetaminophen.

There may be other side effects of Otezla, such as depression and weight loss. Contact your health care provider if you have new or worsening depression, suicidal thoughts, or other mood changes. Monitor your weight regularly while taking Otezla and notify your prescriber of unexplained weight loss. If you have unexplained or concerning weight loss, they may recommend stopping this medicine.

Rarely, Otezla may cause allergic reactions. If you think you are having an allergic reaction to Otezla, stop the medicine and seek medical care right away.

These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

Some medicines may interact with Otezla. Certain medicines that induce (speed up) the CYP450 enzymes can decrease the level of Otezla in your body. This can make Otezla less effective for treating your psoriatic arthritis. Ideally, you will not take Otezla with medicines that are strong inducers of CYP450 enzymes, such as rifampin. 

Always tell your health care provider about everything you take, including medicines and supplements. Sharing this information can help prevent drug interactions. If you take Otezla with other medicines or supplements, tell your health care provider if you think that Otezla is not working effectively. 

Rheumatologists are doctors who may prescribe Otezla. They specialize in the care of patients with joint problems and other conditions involving inflammation. 

Dermatologists may also prescribe Otezla for people living with both psoriasis and psoriatic arthritis. They specialize in the care of patients with skin conditions, such as plaque psoriasis. Otezla may be used to treat both psoriasis and psoriatic arthritis.

Other health care providers may also prescribe Otezla.

Otezla requires a prescription from a health care provider. Treatment usually begins with a starter pack of Otezla, which includes enough medicine for the first 4 weeks of treatment. Your local pharmacy is unlikely to have Otezla. Instead, your health care provider will send your prescription to a specialty pharmacy. They will ship the medicine to your home or doctor’s office. 

A cost assistance program is available from Otezla’s maker that may allow you to pay $0 for your prescription. Whether you qualify to enroll may depend on what type of insurance you have or if you are uninsured. Visit this website from the drugmaker for more information about Otezla costs and copay savings. 

You can also contact the drugmaker at 844-468-3952 to connect with a representative for financial support information and other resources.