THE MOST COMMON ADVERSE REACTIONS THROUGH WEEK 16¹

PALACE 1-3: Adverse reactions reported in ≥2% of patients on Otezla 30 mg twice daily and ≥1% observed in patients on placebo for up to day 112 (week 16)¹

	Placebo		Otezla 30 mg BID
	Day 1 to Day 5 (N = 495)n (%)	Day 6 to Day 112 (N = 490)n (%)	Day 1 to Day 5(N = 497)n (%)	Day 6 to Day 112(N = 493)n (%)
Adverse reaction
Diarrhea^a	6 (1.2)	8 (1.6)	46 (9.3)	38 (7.7)
Nausea^a	7 (1.4)	15 (3.1)	37 (7.4)	44 (8.9)
Headache^a	9 (1.8)	11 (2.2)	24 (4.8)	29 (5.9)
Upper respiratory tract infection^b	3 (0.6)	9 (1.8)	3 (0.6)	19 (3.9)
Vomiting^a	2 (0.4)	2 (0.4)	4 (0.8)	16 (3.2)
Nasopharyngitis^b	1 (0.2)	8 (1.6)	1 (0.2)	13 (2.6)
Upper abdominal pain^b	0 (0.0)	1 (0.2)	3 (0.6)	10 (2.0)

a

Of the reported gastrointestinal adverse reactions, 1 patient experienced a serious adverse reaction of nausea and vomiting in Otezla 30 mg twice daily; 1 patient treated with Otezla 20 mg twice daily experienced a serious adverse reaction of diarrhea; 1 patient treated with Otezla 30 mg twice daily experienced a serious adverse reaction of headache.

b

Of the reported adverse drug reactions, none were serious.

Discontinuation rates due to adverse reactions in the 3 trials¹

Most common adverse reactions leading to discontinuation: nausea (1.8%), diarrhea (1.8%), and headache (1.2%)
Otezla arm 4.6%; placebo arm 1.2%

The majority of patients reporting the most common adverse reactions did so within the first 2 weeks, and the events tended to resolve over time with continued dosing¹

Postmarketing reports of severe diarrhea, nausea, and vomiting have been associated with the use of Otezla. In some cases patients were hospitalized. Monitor patients who are more susceptible to complications of diarrhea or vomiting¹

BID, twice daily; PALACE, Psoriatic Arthritis Long-Term Assessment of Clinical Efficacy.

THE MOST COMMON ADVERSE REACTIONS THROUGH WEEK 260²

PALACE 1-3: Adverse reactions in ≥5% of patients on Otezla 30 mg twice daily, any treatment group²

	Otezla 30 mg twice daily
	Weeks 0 to ≤52 (N = 721) n (%)	Weeks >52 to ≤104 (N = 520) n (%)	Weeks >104 to ≤156 (N = 443) n (%)	Weeks >156 to ≤208 (N = 401) n (%)	Weeks >208 to ≤260 (N = 364) n (%)

Diarrhea	113 (15.7)	20 (3.8)	12 (2.7)	5 (1.2)	2 (0.5)
Nausea	108 (15.0)	11 (2.1)	10 (2.3)	3 (0.7)	1 (0.3)
Headache	75 (10.4)	17 (3.3)	12 (2.7)	8 (2.0)	2 (0.5)
Upper respiratory tract infection	60 (8.3)	27 (5.2)	24 (5.4)	22 (5.5)	21 (5.8)
Nasopharyngitis	41 (5.7)	31 (6.0)	20 (4.5)	27 (6.7)	24 (6.6)

Includes all patients who received Otezla during the time interval relative to the start of Otezla administration.

PALACE, Psoriatic Arthritis Long-Term Assessment of Clinical Efficacy.

Discontinuation due to adverse reactions occurred at 7.9% during weeks 0 to ≤52, 2.5% during weeks >52 to ≤104, 1.6% during weeks >104 to ≤156, 2.0% during weeks >156 to ≤208, and 1.4% during weeks >208 to ≤260²

ADVERSE REACTIONS OF SPECIAL INTEREST²

PALACE 1-3: Adverse reactions of special interest²

Exposure-adjusted incidence rate/100 patient-years^a

	Placebothrough week 16 (145.0 patient-years)	Otezla 30 mg twice dailythrough week 16 (142.6 patient-years)	Otezla 30 mg twice dailythrough week 260 (2196.7 patient-years)
Major adverse cardiac events^b
Events	0.7	0.0	0.3
Malignancies
Hematologic	0.0	0.0	0.1
Skin (excluding melanoma)	2.1	0.0	0.3
Solid	0.7	0.7	0.5
Infections
Non-opportunistic serious	1.4	0.7	1.1
Opportunistic (systemic)	0.0	0.0	0.1
New cases of tuberculosis (TB)^c	0.0	0.0	0.0
Reactivation of TB	0.0	0.0	0.0

a

Exposure-adjusted incidence rate/100 patient-years is 100 times the number (n) of patients reporting the event divided by patient-years (up to the first event start date for patients reporting the event).

b

Major adverse cardiac events (MACE) were defined as TEAEs of acute or fatal myocardial infarction, stroke or fatal stroke, or sudden cardiac death.

c

Patients with a history of active or incompletely treated TB were excluded from the trials. The trials included 32 patients with a medical history of TB (including latent TB and pulmonary TB), or a positive tuberculin test.

PALACE, Psoriatic Arthritis Long-Term Assessment of Clinical Efficacy; TEAEs, treatment-emergent adverse events.

The adverse reactions of special interest were generally similar through 260 weeks²

The Full Prescribing Information for Otezla has no requirement for routine laboratory monitoring¹

PALACE 1-3: Selected marked abnormalities in laboratory parameters²

Laboratory abnormalities reported in the placebo-controlled period and long-term exposure period in patients on Otezla 30 mg twice daily²


	Placebo-controlled^a		Exposure period^b
	Weeks 0 to ≤24	Weeks 0 to ≤24	Weeks 0 to ≤52	Weeks >52 to ≤104	Weeks >104 to ≤156	Weeks >156 to ≤208	Weeks >208 to ≤260
Laboratory parameter	Placebo (N = 495) %, (n/N)	Otezla 30 mg BID (N = 497) %, (n/N)	Otezla 30 mg BID (N = 721) %, (n/N)	Otezla 30 mg BID (N = 520) %, (n/N)	Otezla 30 mg BID (N = 443) %, (n/N)	Otezla 30 mg BID (N = 401) %, (n/N)	Otezla 30 mg BID (N = 364) %, (n/N)
Chemistry
ALT >3x ULN	0.2 (1/492)	1.4 (7/492)	1.3 (9/713)	0.4 (2/518)	0.5 (2/442)	0.2 (1/401)	0.3 (1/363)
AST >3x ULN	0.4 (2/491)	0.4 (2/492)	0.6 (4/713)	0.2 (1/518)	0.7 (3/442)	0.5 (2/401)	0.3 (1/363)
Bilirubin >1.8x ULN	0.0	0.4 (2/492)	0.3 (2/713)	0.4 (2/518)	0.5 (2/442)	0.7 (3/401)	1.1 (4/363)
Creatinine >1.7x ULN	0.2 (1/492)	0.2 (1/492)	0.1 (1/713)	0.0	0.0	0.2 (1/401)	0.3 (1/363)
Cholesterol >7.8 mmol/L^c	2.0 (10/492)	3.5 (17/492)	3.8 (27/713)	2.3 (12/518)	2.9 (13/442)	2.5 (10/401)	2.8 (10/363)
Urate, male >590 μmol/L; female >480 μmol/L^d	2.8 (14/492)	3.5 (17/492)	3.8 (27/713)	3.7 (19/518)	4.3 (19/442)	6.0 (24/401)	3.9 (14/363)
Hematology
Hemoglobin, male <10.5 g/dL; female <8.5 g/dL	0.2 (1/489)	0.4 (2/489)	0.7 (5/713)	0.8 (4/517)	1.1 (5/442)	1.2 (5/401)	1.4 (5/362)
Leukocytes <1.5 x 10⁹/L	0.0	0.0	0.0	0.0	0.0	0.0	0.0
Lymphocytes <0.8 x 10⁹/L	3.5 (17/488)	3.3 (16/489)	3.9 (28/713)	2.9 (15/517)	3.2 (14/442)	2.5 (10/401)	4.4 (16/362)
Neutrophils <1.0 x 10⁹/L	0.4 (2/488)	0.2 (1/489)	0.3 (2/713)	0.6 (3/517)	0.5 (2/442)	0.5 (2/401)	1.1 (4/362)
Platelets <75 x 10⁹/L	0.0	0.0	0.0	0.0	0.2 (1/441)	0.0	0.6 (2/362)

a

Placebo-controlled period includes all data through week 16 for patients initially assigned to placebo who escaped, and all data through week 24 for all other patients.

b

Otezla-exposure period includes all Otezla-exposure data, regardless of when the Otezla exposure started (week 0, 16, or 24).

c

Did not have to be drawn when the patient was fasting.

d

Urate, male >9.9 mg/dL; female >8.1 mg/dL.

ALT, alanine aminotransferase; AST, aspartate aminotransferase; BID, twice daily; PALACE, Psoriatic Arthritis Long-Term Assessment of Clinical Efficacy; ULN, upper limit of normal.

Safety

THE MOST COMMON ADVERSE REACTIONS THROUGH WEEK 16¹

PALACE 1-3: Adverse reactions reported in ≥2% of patients on Otezla 30 mg twice daily and ≥1% observed in patients on placebo for up to day 112 (week 16)¹

Discontinuation rates due to adverse reactions in the 3 trials¹

The majority of patients reporting the most common adverse reactions did so within the first 2 weeks, and the events tended to resolve over time with continued dosing¹

THE MOST COMMON ADVERSE REACTIONS THROUGH WEEK 260²

PALACE 1-3: Adverse reactions in ≥5% of patients on Otezla 30 mg twice daily, any treatment group²

Discontinuation due to adverse reactions occurred at 7.9% during weeks 0 to ≤52, 2.5% during weeks >52 to ≤104, 1.6% during weeks >104 to ≤156, 2.0% during weeks >156 to ≤208, and 1.4% during weeks >208 to ≤260²

ADVERSE REACTIONS OF SPECIAL INTEREST²

PALACE 1-3: Adverse reactions of special interest²

Exposure-adjusted incidence rate/100 patient-years^a

The adverse reactions of special interest were generally similar through 260 weeks²

The Full Prescribing Information for Otezla has no requirement for routine laboratory monitoring¹

PALACE 1-3: Selected marked abnormalities in laboratory parameters²

Laboratory abnormalities reported in the placebo-controlled period and long-term exposure period in patients on Otezla 30 mg twice daily²

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Safety

THE MOST COMMON ADVERSE REACTIONS THROUGH WEEK 161

PALACE 1-3: Adverse reactions reported in ≥2% of patients on Otezla 30 mg twice daily and ≥1% observed in patients on placebo for up to day 112 (week 16)1

Discontinuation rates due to adverse reactions in the 3 trials1

The majority of patients reporting the most common adverse reactions did so within the first 2 weeks, and the events tended to resolve over time with continued dosing1

THE MOST COMMON ADVERSE REACTIONS THROUGH WEEK 2602

PALACE 1-3: Adverse reactions in ≥5% of patients on Otezla 30 mg twice daily, any treatment group2

Discontinuation due to adverse reactions occurred at 7.9% during weeks 0 to ≤52, 2.5% during weeks >52 to ≤104, 1.6% during weeks >104 to ≤156, 2.0% during weeks >156 to ≤208, and 1.4% during weeks >208 to ≤2602

ADVERSE REACTIONS OF SPECIAL INTEREST2

PALACE 1-3: Adverse reactions of special interest2

Exposure-adjusted incidence rate/100 patient-yearsa

The adverse reactions of special interest were generally similar through 260 weeks2

The Full Prescribing Information for Otezla has no requirement for routine laboratory monitoring1

PALACE 1-3: Selected marked abnormalities in laboratory parameters2

Laboratory abnormalities reported in the placebo-controlled period and long-term exposure period in patients on Otezla 30 mg twice daily2

You are leaving the Otezla® (apremilast) website

Are You a Healthcare Professional?

THE MOST COMMON ADVERSE REACTIONS THROUGH WEEK 16¹

PALACE 1-3: Adverse reactions reported in ≥2% of patients on Otezla 30 mg twice daily and ≥1% observed in patients on placebo for up to day 112 (week 16)¹

Discontinuation rates due to adverse reactions in the 3 trials¹

The majority of patients reporting the most common adverse reactions did so within the first 2 weeks, and the events tended to resolve over time with continued dosing¹

THE MOST COMMON ADVERSE REACTIONS THROUGH WEEK 260²

PALACE 1-3: Adverse reactions in ≥5% of patients on Otezla 30 mg twice daily, any treatment group²

Discontinuation due to adverse reactions occurred at 7.9% during weeks 0 to ≤52, 2.5% during weeks >52 to ≤104, 1.6% during weeks >104 to ≤156, 2.0% during weeks >156 to ≤208, and 1.4% during weeks >208 to ≤260²

ADVERSE REACTIONS OF SPECIAL INTEREST²

PALACE 1-3: Adverse reactions of special interest²

Exposure-adjusted incidence rate/100 patient-years^a

The adverse reactions of special interest were generally similar through 260 weeks²

The Full Prescribing Information for Otezla has no requirement for routine laboratory monitoring¹

PALACE 1-3: Selected marked abnormalities in laboratory parameters²

Laboratory abnormalities reported in the placebo-controlled period and long-term exposure period in patients on Otezla 30 mg twice daily²