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Trial of Apremilast for Oral Ulcers in Behçet's Syndrome

Authors
 Gülen Hatemi  ;  Alfred Mahr  ;  Yoshiaki Ishigatsubo  ;  Yeong‑Wook Song  ;  Mitsuhiro Takeno  ;  Doyoung Kim  ;  Melike Melikoğlu  ;  Sue Cheng  ;  Shannon McCue  ;  Maria Paris  ;  Mindy Chen  ;  Yusuf Yazici 
Citation
 NEW ENGLAND JOURNAL OF MEDICINE, Vol.381(20) : 1918-1928, 2019 
Journal Title
 NEW ENGLAND JOURNAL OF MEDICINE 
ISSN
 0028-4793 
Issue Date
2019
MeSH
Administration, Oral ; Adult ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use* ; Area Under Curve ; Behcet Syndrome/complications ; Behcet Syndrome/drug therapy* ; Double-Blind Method ; Female ; Humans ; Male ; Oral Ulcer/drug therapy* ; Oral Ulcer/etiology ; Phosphodiesterase 4 Inhibitors/adverse effects ; Phosphodiesterase 4 Inhibitors/therapeutic use* ; Quality of Life ; Thalidomide/adverse effects ; Thalidomide/analogs & derivatives* ; Thalidomide/therapeutic use
Abstract
BACKGROUND: The small-molecule phosphodiesterase 4 inhibitor apremilast modulates cytokines that are up-regulated in Behçet's syndrome. In a phase 2 trial involving patients with Behçet's syndrome, apremilast reduced the incidence and severity of oral ulcers. Data on the efficacy and safety of apremilast in patients with Behçet's syndrome who had active oral ulcers and had not previously received biologic agents are limited. METHODS: In a phase 3 trial, we randomly assigned, in a 1:1 ratio, patients who had Behçet's syndrome with active oral ulcers but no major organ involvement to receive either apremilast at a dose of 30 mg or placebo, administered orally, twice daily for 12 weeks, followed by a 52-week extension phase. The primary end point was the area under the curve (AUC) for the total number of oral ulcers during the 12-week placebo-controlled period (with lower values indicating fewer ulcers). There were 13 secondary end points, including complete response of oral ulcers, change from baseline in pain associated with oral ulcers, disease activity, and change from baseline in the Behçet's Disease Quality of Life score (range, 0 to 30, with higher scores indicating greater impairment in quality of life). Safety was also assessed. RESULTS: A total of 207 patients underwent randomization (104 patients to the apremilast group and 103 to the placebo group). The AUC for the number of oral ulcers was 129.5 for apremilast, as compared with 222.1 for placebo (least-squares mean difference, -92.6; 95% confidence interval [CI], -130.6 to -54.6; P<0.001). The change from baseline in the Behçet's Disease Quality of Life score was -4.3 points in the apremilast group, as compared with -1.2 points in the placebo group (least-squares mean difference, -3.1 points; 95% CI, -4.9 to -1.3). Adverse events with apremilast included diarrhea, nausea, and headache. CONCLUSIONS: In patients with oral ulcers associated with Behçet's syndrome, apremilast resulted in a greater reduction in the number of oral ulcers than placebo but was associated with adverse events, including diarrhea, nausea, and headache. (Funded by Celgene; ClinicalTrials.gov number, NCT02307513.).
Full Text
https://www.nejm.org/doi/full/10.1056/NEJMoa1816594
DOI
10.1056/NEJMoa1816594
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Dermatology (피부과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영) ORCID logo https://orcid.org/0000-0002-0194-9854
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/174562
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