450 The use of apremilast in the treatment of patients with lichen planus

Abstract

Intro: Lichen planus (LP) is a relatively common dermatologic disease without an approved FDA indication. There is a need for treatments with minimal adverse effects and contraindications to comorbidities seen in LP patients. Apremilast is a phosphodiesterase 4 inhibitor FDA approved for plaque psoriasis, psoriatic arthritis, and Behcet’s disease. Methods: A retrospective analysis of medical records for 11 patients who had been prescribed apremilast 30 mg twice daily for LP was conducted. Inclusion criteria included patients who had documented use of apremilast, at least one follow-up and post-treatment documentation. Results: Seven patients met inclusion criteria, while four were excluded due to lack of insurance coverage. Patients’ ages ranged 31-67, with an average age of 54.4 and six (85.7%) were male. All patients were previously treated with other agents including topical, intralesional and oral corticosteroids, acitretin, methotrexate, cyclosporine and metronidazole. Three (57.1%) were treated simultaneously with topical agents. Two patients had cutaneous only, two had mucosal only and three had both papular and mucosal LP. Six (85.7%) had clinical improvement in symptoms after treatment with apremilast. Two (28.6%) had significant improvement and three (42.9%) were clear. Four (57.1%) had no loss in response after being treated with apremilast for more than one year. Three (42.9%) experienced mild side effects such as headache, diarrhea, and insomnia. Discussion: Apremilast, an oral phosphodiesterase-4 (PDE-4) inhibitor, has promise to be an efficacious treatment option for LP. In this study, the use of apremilast at 30 mg twice a day was associated with a response for a majority of patients and was well tolerated. Further studies are warranted to better explore the use of apremilast in lichen planus.