Apremilast Mechanism — SCE Rheumatology MCQ
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Correct answer: A — Phosphodiesterase 4 (PDE4) inhibition
Apremilast is an oral small-molecule phosphodiesterase 4 (PDE4) inhibitor. PDE4 is a cAMP-specific enzyme that is prominent in inflammatory cells. Its inhibition increases intracellular cAMP and modulates the production of pro-inflammatory and anti-inflammatory mediators; apremilast does not directly block an individual cytokine. TNF-alpha inhibition describes agents such as adalimumab, while IL-12/23 inhibition describes ustekinumab. Secukinumab and ixekizumab inhibit IL-17A. JAK inhibition is the mechanism of targeted synthetic DMARDs such as tofacitinib and upadacitinib. Therefore, PDE4 inhibition is the unique best answer.
Reference: Otezla 10 mg, 20 mg and 30 mg film-coated tablets, Summary of Product Characteristics, section 5.1 Pharmacodynamic properties: Mechanism of action, updated 18 June 2026. https://www.medicines.org.uk/emc/product/3648/smpc