Cosentyx and Otezla Together for Psoriasis

Psoriasis is a chronic autoimmune inflammatory disorder of the skin, nails, and joints. Skin is the most commonly affected organ, however, isolated nail psoriasis and joint involvement with or without skin and nail involvement are not rare.

It is characterized by the formation of thick, red, scaly patches on the skin, which may be itchy, painful, and sometimes bleed. Psoriasis can occur on any part of the body but is most commonly found on the extensor surfaces of the body parts such as the elbows, knees, scalp, and lower back.

Psoriasis is thought to be the result of immune dysfunction in which T-cells mistakenly attack healthy skin, nails, and joints.

Psoriasis can range in severity from mild to severe and can have a significant impact on a person’s quality of life, causing embarrassment, social isolation, and even depression. While there is no cure for psoriasis, there are a variety of treatments available that can help manage the symptoms and improve quality of life.

Medicines Used for the Treatment of Psoriasis:

The treatment of psoriasis is evolving with more and more targeted therapies being invented and marketed.

During the last five years, the FDA has approved about five more drugs for the treatment of Psoriasis. Here is a list of the drugs which have been approved recently:

However, because of the side effects, cost of medicines, availability, and variable efficacies, any of the following drugs can be used for the treatment of psoriasis.

The decision to initiate any specific therapy should always be made with the help of a healthcare provider who is an expert in dealing with these cases.

Here is a list of all the medicines used in the treatment of Psoriasis:

Which drugs are the most effective for the treatment of Psoriasis?

Among the highly effective drugs, the following drugs are considered to have the greatest efficacies in the treatment of psoriasis:

• Biologics:

Biologic medications, such as adalimumab, etanercept, infliximab, ustekinumab, secukinumab, and Ixekizumab, have been shown to be highly effective in treating psoriasis.

These medications work by targeting specific molecules in the immune system that are involved in the development of psoriasis.

Biologics are usually reserved for people with moderate to severe psoriasis who have not responded to other treatments.

• Apremilast:

Apremilast is an oral medication that works by blocking an enzyme called phosphodiesterase 4 (PDE4), which is involved in the inflammatory response. It has been shown to be effective in treating moderate to severe psoriasis.

• Methotrexate:

Methotrexate is an immunosuppressant medication that is commonly used to treat psoriasis. It works by slowing down the growth of skin cells and reducing inflammation.

Methotrexate can be effective in treating moderate to severe psoriasis, but it does have some potential side effects and requires careful monitoring.

• Cyclosporine:

Cyclosporine is another immunosuppressant medication that is sometimes used to treat psoriasis. It works by suppressing the immune system, which can reduce inflammation and slow down the growth of skin cells.

Cyclosporine can be effective in treating severe psoriasis, but it also has potential side effects and requires careful monitoring.

How effective is Cosentyx for Psoriasis?

Cosentyx (secukinumab) has been shown to be highly effective in the treatment of moderate to severe psoriasis in clinical trials.

In one study, after 12 weeks of treatment with Cosentyx, more than 80% of patients achieved at least a 75% reduction in the severity of their psoriasis symptoms. This is known as a “PASI 75” response. In comparison, only 4% of patients in the placebo group achieved a PASI 75 response [Ref].

Overall, Cosentyx has been shown to be highly effective for the treatment of psoriasis, with a favorable safety profile.

What are the FDA-approved indications of Cosentyx?

Cosentyx (secukinumab) is a medication that is used to treat several autoimmune conditions, including psoriasis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis. The FDA has approved Cosentyx for the following indications:

• Plaque psoriasis:

Cosentyx is indicated for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy.

• Psoriatic arthritis:

Cosentyx is indicated for the treatment of active psoriatic arthritis in adult patients, alone or in combination with methotrexate.

• Ankylosing spondylitis:

Cosentyx is indicated for the treatment of active ankylosing spondylitis in adult patients.

• Non-radiographic axial spondyloarthritis:

Cosentyx is indicated for the treatment of active non-radiographic axial spondyloarthritis in adult patients.

How effective is Otezla for Psoriasis?

Otezla (apremilast) is a medication used for the treatment of psoriasis, and it has been shown to be moderately effective in clinical studies.

In these studies, patients with moderate to severe plaque psoriasis who received Otezla experienced significant improvements in their skin condition compared to those who received a placebo.

In one study, after 16 weeks of treatment, about 33% of patients who received Otezla achieved a “PASI 75” response, which means at least a 75% reduction in the severity of their psoriasis symptoms. In comparison, only 5% of patients in the placebo group achieved a PASI 75 response [Ref].

In another study, after 16 weeks of treatment, about 28% of patients who received Otezla achieved a PASI 75 response. These results suggest that the efficacy of Otezla may be sustained over the long term, with continued use.

Here is the table of results [Ref]:

While Otezla may not be as effective as some other treatments for psoriasis, it may be a good option for patients who are unable to take other medications due to contraindications or side effects.

Otezla also has a favorable safety profile and may be more convenient for patients who prefer an oral medication over an injectable or infusion.

What are the FDA-approved indications of Otezla?

Otezla (apremilast) is a medication used to treat several autoimmune and inflammatory conditions. The FDA has approved Otezla for the following indications:

• Psoriasis:

Otezla is indicated for the treatment of patients with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy.

• Psoriatic arthritis:

Otezla is indicated for the treatment of adult patients with active psoriatic arthritis.

• Oral ulcers associated with Behçet’s disease:

Otezla is indicated for the treatment of adult patients with oral ulcers associated with Behçet’s disease.

Differences between the efficacies of Cosentyx and Otezla in Psoriasis:

Cosentyx has been shown to be more effective than Otezla in clinical studies for the treatment of psoriasis, with a higher proportion of patients achieving significant improvement in their psoriasis symptoms.

However, it is important to note that the efficacy of each medication may vary from patient to patient, and the choice of treatment should be based on individual patient characteristics and preferences, as well as the expertise of the healthcare provider.

Here is a table of the comparison of the efficacies of Cosentyx and Otezla:

Similarities and differences between Cosentyx and Otezla:

Cosentyx is an IL-17A inhibitor that is administered as a subcutaneous injection, while Otezla is a PDE4 inhibitor that is taken orally as a tablet.

Cosentyx is an IL-17A inhibitor that is administered as a subcutaneous injection, while Otezla is a PDE4 inhibitor that is taken orally as a tablet.

Cosentyx and Otezla Together for Psoriasis:

The combination of Cosentyx and Otezla together has been tried successfully in case reports of patients who had a resistant form of psoriasis.

In one case report, Cosentyx and Otezla were prescribed together for the treatment of recalcitrant plaque psoriasis in a 67-year-old man.

The patient was non-responsive to multiple medications and failed to respond to topical, systemic, and biological therapies. When Cosentyx and Otezla were used together, a significant improvement in the symptoms was noted with minimal side effects [Ref].

Because Otezla (Apremilast) has a different mechanism of action than most other biological therapies, it has also been studied in patients in combination with biological treatment in the background.

One retrospective study that comprised 22 patients, concluded that Otezla can be safely added to the treatment of regimen of patients with psoriasis who are also on a Biological treatment for their illness [Ref]

What are the side effects of combining Cosentyx and Otezla together for Psoriasis:

The use of Cosentyx and Otezla together has not been extensively studied, and there is limited clinical data available on the safety and efficacy of using these medications in combination.

However, both medications have the potential to cause side effects, and combining them may increase the risk of side effects.

Common side effects of Cosentyx can include:

• Injection site reactions, such as redness, swelling, or pain
• Diarrhea
• Upper respiratory tract infections, such as the common cold
• Headache
• Hypertension (high blood pressure)

Common side effects of Otezla can include:

• Diarrhea
• Nausea
• Headache
• Upper respiratory tract infections, such as the common cold
• Decreased appetite
• Depression or suicidal thoughts (rare)

Combining these medications may increase the risk of certain side effects, such as gastrointestinal symptoms like diarrhea or nausea.

Additionally, both medications can have effects on the immune system, and combining them may increase the risk of infections or other immune-related complications.

Diarrhea, headache, and upper respiratory tract infections are side effects that are common in both conditions and it is likely that the incidence of these adverse reactions may increase.

To Summarize:

Psoriasis is an embarrassing condition of the skin resulting in social isolation and depression. Novel biological treatments are being investigated to minimize the symptoms of patients who have moderate to severe psoriasis and are resistant to conventional therapies.

The combination of Cosentyx and Otezla Together is another attractive option for patients who have an inadequate response to either drug alone.