Apremilast Mechanism — SCE Rheumatology MCQ
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Correct answer: A — An oral phosphodiesterase 4 inhibitor that increases intracellular cyclic AMP; typical adverse effects include diarrhoea, nausea and headache
Explanation lettering: D = shown as A · A = shown as B · B = shown as C · E = shown as D · C = shown as E
Apremilast is an oral small-molecule phosphodiesterase 4 inhibitor. Inhibiting PDE4 raises intracellular cyclic AMP in inflammatory cells, modulating mediators including TNF-alpha, IL-17 and IL-23 and increasing anti-inflammatory signalling such as IL-10. Diarrhoea and nausea are the most frequent adverse reactions in psoriatic arthritis and usually occur early; headache is also typical. Clinically significant weight loss is recognised and warrants monitoring, particularly in underweight patients, but the UK SmPC classifies weight decrease as uncommon rather than common. Apremilast does not directly inhibit JAK, TNF, IL-17 or IL-23; these mechanisms describe other targeted synthetic or biological DMARD classes represented by options A, B, C and E.
Reference: Otezla (apremilast) film-coated tablets, Summary of Product Characteristics, sections 4.8 and 5.1, electronic medicines compendium (UK), current version. https://www.medicines.org.uk/emc/product/10709/smpc