Otezla alternatives: What can I take instead of Otezla?

Compare Otezla alternatives | Tumor Necrosis Factor Inhibitor (TNFi) Biologics | Interleukin-17 (IL17) Inhibitor Biologics | Interleukin 12/23 Inhibitor Biologic | CTLA4 Immunoglobulin | Oral Small Molecule Drugs | Natural alternatives | How to switch meds

Psoriatic arthritis, also referred to as PsA, is an inflammatory disorder of the immune system where your body’s own immune system attacks your joints and the connections between tendons, ligaments, and bones. This ultimately leads to stiff joints, pain, and swelling. If left untreated, you can lose function of the joint entirely. PsA is known as an autoimmune disease because it is a condition where your body’s immune system is attacking its own healthy tissue. Typically, patients who are diagnosed with psoriatic arthritis already suffer from psoriasis which presents as red, raised, scaly, and inflamed patches of skin. PsA typically affects the joints of the spine, neck, lower back, and hips. There are other associated symptoms with psoriatic arthritis which include fatigue, tenderness in the foot or heel, painful swelling of fingers and toes, and changes to your nails (pitting). PsA can cause eye swelling leading to pain, redness, blurry vision, or even loss of vision. Symptoms of inflammatory bowel disease (IBS) may also be present.

Scientists do not fully understand why psoriatic arthritis attacks healthy tissues, but believe it is a combination of genetic factors and environmental factors like obesity, injury, or infection. Fortunately, there have been many successful treatments developed to control the disease and symptomatology of chronic inflammation and pain. Biologic antirheumatic drugs can modify the course of the actual disease. Drugs such as steroids or over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) help treat the pain and inflammation. Disease modifying rheumatoid arthritis drugs (DMARDs) both help with symptoms and slow the progression of the disease. Psoriatic arthritis can be treated by a variety or combination of healthcare specialties including rheumatologists, dermatologists, and primary care physicians.

DMARDs have been used in many autoimmune disease states to successfully slow progression of the disease. This can include atopic dermatitis, Lyme disease, rheumatoid arthritis, and Lupus just to name a few. Otezla (apremilast) is a DMARD that specifically has been used to treat active psoriatic arthritis successfully. It is an oral phosphodiesterase-4 (PDE4) inhibitor and is specifically considered a targeted synthetic DMARD. Otezla is approved by the Food and Drug Administration (FDA) for other uses including ulcers related to Behcet’s disease and plaque psoriasis, where it is recommended as first-line treatment. Treatment guidelines published by the American College of Rheumatology suggest that biologics may be most useful in PsA as first-line treatment, but Otezla holds a place in therapy for those for whom PsA remains active on biologic therapy and/or for whom older first-generation DMARDs are not successful.

RELATED: What is Otezla?

What can I take in place of Otezla?

There are a variety of prescription drugs which can be alternative treatments in place of Otezla. Symptomatic treatments such as steroids and NSAIDs can provide symptomatic relief but will not alter the course of the disease. Oral small molecule drugs (OSMs) such as methotrexate or cyclosporine have been used in PsA, and although typically more cost-effective, they are not always effective on their own. 

There are several different types of biologic agents which have shown efficacy amongst active PsA patients including tumor necrosis factor inhibitors (TNFi) such as Enbrel (etanercept) and Humira (adalimumab). The following table is not meant to be medical advice, but is meant to provide you with alternative or conjunctive treatments to Otezla. Consult the prescribing information for each drug listed for more information.

Other alternatives to Otezla

• Simponi (golimumab)
• Cimzia (certolizumab pegol)
• Taltz (ixekizumab)
• Siliq (brodalumab)
• Decadron (dexamethasone)
• Medrol (methylprednisolone)
• Deltasone (prednisone)
• Aspirin (ASA)

Top 5 Otezla alternatives

The following are some of the most common alternatives to Otezla.

1. Tumor Necrosis Factor Inhibitor (TNFi) Biologics (etanercept, infliximab, adalimumab)

TNFi biologic drugs help improve the signs and symptoms of PsA and other inflammatory autoimmune diseases. TNF is a cytokine produced by the T-cells of the immune system and cause inflammation and joint destruction. TNFi biologics slow the progression of structural joint damage and improve physical function. It can be used alone or in conjunction with a DMARD drug. It is considered a first-line treatment. TNFi biologics are injectable, which may not be desirable by the patient, but they are not injected frequently, no more than once weekly.

2. Interleukin-17 (IL17) Inhibitor Biologics (secukinumab, ixekizumab, brodalumab)

IL17 inhibitor biologics bind to a specific cytokine, interleukin-17, and prevent it from interacting with the IL17 receptor. Interleukin-17 plays a role in normal inflammatory and immune responses, but elevated levels can cause inflammation, plaque psoriasis, and joint damage. These drugs are also injectable, but do not have to be given every day.

3. Interleukin 12/23 Inhibitor Biologic (ustekinumab)

IL 12/23 inhibitor biologics are monoclonal antibodies that block the effects of interleukin 12 and 23 which also play a role in normal immune and inflammatory responses. Ustekinumab disrupts the normal signaling process when levels of IL 12 and IL 23 are elevated. This decreases the amount of inflammation and damage done in many autoimmune diseases.

RELATED: Everything you need to know about biologics for psoriasis

4. CTLA4 Immunoglobulin (abatacept)

Abatacept is a human recombinant fusion protein which serves as a signal blocker of T-cell activation. The slowing of T-cell activation slows the initiation of inflammatory processes which lead to plaque psoriasis and arthritis-related symptoms such as joint pain and inflammation. Abatacept is injected subcutaneously once weekly.

5. Oral Small Molecule Drugs (methotrexate, sulfasalazine, cyclosporine)

There are a variety of oral medications which can mediate an overactive immune response in autoimmune disorders. They each work in different ways, and are typically dosed once or multiple times daily by mouth. This group of drugs are generally generic and more cost efficient. These also may be used in combination with some of the above alternatives.

Natural alternatives to Otezla

Many healthcare professionals will stress the importance of non-pharmacologic treatment usually in addition to any pharmacologic treatment. Physical and occupational therapy play an important role in the ongoing health and use of the joints. Phototherapy will help with the dermatological manifestations on PsA. Massage therapy and exercise also play an important role. Smoking and obesity are risk factors for psoriatic arthritis. Naturally, most treatment plans include a timeline for smoking cessation and weight loss. 

There are natural supplements which may play a role in symptom relief. Turmeric and omega-3-fatty acids have anti-inflammatory properties thought to help with the pain and inflammation associated with psoriatic arthritis. Soaking in baths of epsom salt with magnesium is also thought to help with the inflammation and provide pain relief. A topical magnesium preparation may also be helpful. There is no vitamin that is a cure for psoriasis or psoriatic arthritis, but natural supplements and non-pharmacologic treatments may have an important place in therapy. 

How to switch to a Otezla alternative

It is important to know that only your healthcare provider can determine if Otezla or one of these suggested alternatives is right for you and your condition. With an uninsured price of over $5700 per month on average, Otezla may be cost-prohibitive, even when you are insured. Otezla is a brand name only drug with no generic available on the market. In addition, Otezla may not be covered by your Medicare plan. A SingleCare discount card can help with savings if cost is a concern. 

Otezla can cause severe adverse effects such as cases of diarrhea, nausea, and vomiting. Some cases are so severe they lead to hospitalization. You may also have an allergic reaction to Otezla, though that is rare. For these patients, Otezla therapy may no longer be an option. Otezla and many of its alternatives can cause a change in your body’s own immune response to other injuries or infections. It may also cause drug interactions with therapy you are already taking. This may leave you vulnerable to serious injury and infection when taking Otezla.

If you feel that you may want to try an alternative to Otezla, you will need to speak to your doctor. Your local pharmacist can help with answering questions about insurance coverage and cost, and whether alternative treatment options would be more affordable.

It is important to know you should never just stop your Otezla without speaking to your doctor first. Only your healthcare professional can help you determine the best way to treat psoriatic arthritis in your case.