16415 Combination therapy of apremilast and biologic agent as a step-up strategy option of psoriasis and psoriatic arthritis

The treatment of psoriatic arthritis and psoriasis is complicated by heterogeneity in the presentation of the disease (skin and nail disease, arthritis, enthesitis, dactylitis, and axial involvement) and its course. While monotherapy with biologic agents is effective for many patients, some patients with aggressive disease are not controlled by standard treatment and require combination therapies. Each domain is regulated by a different cytokine. Biologic drugs exclusively block one cytokine while apremilast modulates a wide array of inflammatory mediators.