What are Target-Specific DMARDs?

Disease-modifying anti-rheumatic drugs (DMARDs) are medications that not only reduce the symptoms of psoriatic arthritis (PsA), they also slow or prevent the disease from progressing. DMARDs work on the causes of inflammation, which is overactive in people with PsA, potentially lessening the long-term damage to joints which can cause disability. There are different types of DMARDs: traditional (or non-biologic), biologic, and target-specific. Target-specific DMARDs work by specifically targeting certain cellular enzymes to help reduce the inflammatory response that causes joint pain, swelling, and stiffness. While biologic DMARDs also target specific molecules, biologic DMARDs are made in the laboratory from living sources.

What is Otezla® (apremilast)?

Otezla is a target-specific DMARD that is a phosphodiesterase 4 (PDE4) inhibitor. PDE4 is an enzyme that contributes to the inflammatory process. Studies have shown that by blocking the PDE4 enzyme, key features of the immune response are suppressed, including the recruitment and activation of inflammatory cells. In people with PsA, the inflammatory process is overactive and causes swelling and pain in the joints, and treatment with Otezla can reduce the symptoms of PsA and reduce the long-term damage that chronic inflammation can cause to the joints.1,2

Apremilast may cause side effects, such as diarrhea, nausea, stomach pain, vomiting, headache, sore throat, cough, fever, sneezing, runny nose, and nasal congestion. The most common side effects experienced in clinical trials were diarrhea, nausea, upper respiratory tract infections and headache. The majority of patients reporting diarrhea and nausea experienced these symptoms during the first two weeks of treatment. Side effects generally improved over time without stopping apremilast. Some patients taking apremilast lost body weight. Patients should monitor their body weight and discuss any unexplained weight loss with their doctors.1,3

Apremilast is associated with an increase in depression. Patients who have or have had depression should discuss their condition with their doctor before taking apremilast. During treatment, patients should contact their doctor if they experience any feelings of depression, suicidal thoughts or suicidal behavior.1,3

What is Xeljanz?

Xeljanz and the extended-release version Xeljanz XR are Janus kinase (JAK) inhibitors. JAK is a type of cytokine, or chemical messenger, that is believed to play a role in inflammation. In conditions like PsA, the inflammatory response is overactive, and JAK inhibitors can reduce the inflammation and may stop joint damage that can be a long-term complication of PsA.

Xeljanz may cause side effects, and some of them may be serious, including reducing a person’s ability to fight infections. Some infections can be life-threatening, and people should be tested for tuberculosis (TB) before starting treatment with Xeljanz. The most common side effects experienced with Xeljanz are upper respiratory infections, colds, headache, changes in cholesterol levels and diarrhea.

Important information about DMARDs

Any person who is considering taking a DMARD should talk to their doctor about all their health conditions, including if they are pregnant, breastfeeding, or planning to become pregnant or breastfeed. Some medications may not be safe to take while pregnant or breastfeeding.

In addition, individuals should discuss with their doctor about all medications (prescription and over-the-counter), vitamins, and supplements they are taking. Some medications are not safe to take together, or they may be less effective when used in combination with other products.

This list of drugs and side effects is not exhaustive. Side effects and symptoms may vary depending on dosage, frequency, and prescription of treatment.

Written by: Emily Downward | Last reviewed: February 2020.

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Last reviewed: February 2021.