title: A pilot study of an oral phosphodiesterase inhibitor (apremilast) for atopic dermatitis in adults.
abstract: OBJECTIVE
  To investigate the preliminary safety and efficacy of apremilast, an oral phosphodiesterase 4 inhibitor, for atopic dermatitis.
  
  
  METHODS
  This investigator-initiated, open-label pilot study evaluated 2 doses of apremilast in patients with atopic dermatitis. Differential gene analysis was performed from peripheral whole blood using data before and after treatment.
  
  
  METHODS
  University-based dermatology clinical research unit.
  
  
  METHODS
  Sixteen adult patients with atopic dermatitis.
  
  
  METHODS
  A specific phosphodiesterase 4 inhibitor, apremilast.
  
  
  METHODS
  The primary outcome was incidence of adverse events. Secondary outcomes included the differences in pruritus, Dermatology Life Quality Index (DLQI), and Eczema Area and Severity Index (EASI) scores between the baseline visit and end-ofstudy visit for each cohort.
  
  
  RESULTS
  The group receiving apremilast, 20 mg twice daily, displayed a significant reduction from baseline of pruritus (P=.02) and the DLQI (P=.003) at 3 months. The group receiving apremilast, 30 mg twice daily, displayed a significant reduction of the EASI (P=.008) and the DLQI (P=.01) at 3 months. At 6 months, there was a significant reduction of the EASI (P=.002), the visual analog scale (P=.03), and the DLQI (P=.03). Gene ontologic analyses comparing baseline with samples during treatment revealed alterations in immune response pathways, especially those related to cyclic adenosine monophosphate–mediated signaling.
  
  
  CONCLUSIONS
  These results support further development of apremilast for treatment of atopic dermatitis. Larger randomized controlled studies are needed to more adequately evaluate both safety and efficacy. Limitations include the small sample size and absence of a control.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01393158.
authors.affiliation: Department of Dermatology, University of California, Los Angeles, USA.
authors.forename: Aman
authors.initials: A
authors.lastname: Samrao
authors.forename: Trista M
authors.initials: TM
authors.lastname: Berry
authors.forename: Renato
authors.initials: R
authors.lastname: Goreshi
authors.forename: Eric L
authors.initials: EL
authors.lastname: Simpson
mesh_terms: D000328:Adult; D017362:Cyclic AMP Response Element-Binding Protein / Q000097:blood / Q000187:drug effects / Q000235:genetics; D003876:Dermatitis, Atopic / Q000097:blood / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D018664:Interleukin-12 / Q000097:blood / Q000235:genetics; D008264:Macrophages / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000187:drug effects; D009325:Nausea / Q000209:etiology; D020411:Oligonucleotide Array Sequence Analysis; D058988:Phosphodiesterase 4 Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D010865:Pilot Projects; D011537:Pruritus / Q000188:drug therapy; D011788:Quality of Life; D012720:Severity of Illness Index; D015398:Signal Transduction / Q000187:drug effects / Q000235:genetics; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D017362:Cyclic AMP Response Element-Binding Protein; D058988:Phosphodiesterase 4 Inhibitors; D018664:Interleukin-12; D013792:Thalidomide; C505730:apremilast