PDE4 inhibition in pediatric psoriasis: analysis of the SPROUT study on apremilast

Introduction Moderate-to-severe plaque psoriasis in the pediatric population represents a complex therapeutic challenge. Although the advent of biologic drugs (anti-TNF, anti-IL17) has revolutionized efficacy standards, there remains an unmet need for oral, safe therapeutic options that do not require regular monitoring. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, has recently been evaluated in this population. Areas covered This review analyzes the 16-week and 52-week results of the phase 3 SPROUT trials which evaluated the efficacy and safety of apremilast in children and adolescents (aged 6-17 years) with moderate-to-severe plaque psoriasis. Data show that apremilast offers significant improvement compared to placebo at Week 16, with a response profile maintained through Week 52. Expert opinion Although the efficacy of apremilast is lower compared to modern biologics (e.g. secukinumab, ixekizumab), the drug offers unique practical advantages: oral administration, absence of pre-treatment screening for tuberculosis and chronic hepatitis, and no requirement for laboratory monitoring. With patent expiration and the arrival of generics, apremilast may represent a potential cost-effective 'first-line systemic' option for pediatric patients who are not candidates for or are reluctant to accept injectable therapies.