Otezla (apremilast) is a prescription oral medication used to treat three conditions: plaque psoriasis, psoriatic arthritis, and oral ulcers caused by Behçet’s disease. It works differently from injectable biologics, targeting inflammation through a specific enzyme pathway, and it’s taken as a pill twice daily.
Plaque Psoriasis
Otezla is approved for adults with plaque psoriasis who are candidates for light therapy or other systemic treatments, and for children ages 6 and older (weighing at least 20 kg) with moderate to severe plaque psoriasis. It’s often considered when topical creams alone aren’t enough but the patient wants to avoid injections.
Otezla has also been specifically studied for scalp psoriasis, which can be particularly stubborn to treat. In a clinical trial of 303 adults with moderate to severe scalp involvement, 43.3% of patients on Otezla achieved clear or almost-clear skin on the scalp at 16 weeks, compared to just 13.7% on placebo. That’s a meaningful difference for people dealing with visible flaking and irritation in a hard-to-treat area.
Psoriatic Arthritis
Psoriatic arthritis causes joint pain, stiffness, and swelling alongside skin symptoms. Otezla is approved for adults and children 6 and older (at least 20 kg) with active psoriatic arthritis. In a phase 3 trial published in the Annals of the Rheumatic Diseases, 40% of patients taking the standard dose achieved at least a 20% improvement in joint symptoms by week 16, compared to 19% on placebo. That measure, known as ACR20, tracks pain, swelling, and physical function together.
Otezla isn’t the most powerful option for severe joint damage. Biologic injections tend to produce higher response rates. But for people with mild to moderate joint involvement, or those who prefer an oral medication, it offers a reasonable middle ground between topical treatments and biologics.
Oral Ulcers From Behçet’s Disease
Behçet’s disease is a rare inflammatory condition that causes painful, recurring mouth sores along with other symptoms. Otezla is the first FDA-approved treatment specifically for oral ulcers associated with Behçet’s. In a long-term study tracking patients over 18 months, 93.3% had complete resolution of oral ulcers at 6 months, and 92.3% maintained that result at 12 months. By 18 months the rate dropped to 66.7%, suggesting some patients may see ulcers return over time, but the initial response is strong.
How Otezla Works
Otezla belongs to a class of drugs called PDE4 inhibitors. PDE4 is an enzyme inside immune cells that helps regulate inflammation. By blocking this enzyme, Otezla raises levels of a signaling molecule called cyclic AMP inside those cells, which dials down the production of inflammatory proteins while boosting anti-inflammatory ones. The net effect is a rebalancing of the immune response rather than a broad suppression of it.
This is a key distinction from biologics, which block specific immune proteins in the bloodstream. Because Otezla works inside cells on a regulatory pathway, it doesn’t carry the same infection risks that come with injectable immune-suppressing drugs. You don’t need tuberculosis screening or regular blood work before or during treatment, which simplifies the process considerably.
Common Side Effects
The most frequent side effects are gastrointestinal. In the scalp psoriasis trial, 31% of patients experienced diarrhea and 22% reported nausea. Rates were similar in Behçet’s disease trials: 41% diarrhea, 19% nausea. These symptoms tend to be worst during the first few weeks and often improve as the body adjusts. Headaches affected about 12 to 14% of patients across studies, and upper respiratory infections occurred in roughly 9 to 12%.
Weight loss is another effect worth knowing about. In plaque psoriasis trials, 12% of adults on Otezla lost between 5% and 10% of their body weight, compared to 5% on placebo. Similar patterns appeared in psoriatic arthritis (10% versus 3.3%) and in pediatric patients (12% versus 2.5%). This isn’t always unwelcome, but unexplained weight loss should be monitored, especially in people who are already underweight.
Mental Health Considerations
Otezla carries a warning about depression and mood changes. In clinical trials, 1.0% of patients on Otezla reported depression compared to 0.8% on placebo, a small absolute difference. Suicidal thoughts or behavior occurred in 0.2% of Otezla patients and none on placebo, though notably, the only completed suicides in the trials occurred in the placebo group. The numbers are low, but the FDA requires monitoring. If you have a history of depression, it’s worth discussing before starting treatment and paying attention to mood shifts in the early weeks.
How It’s Taken
Otezla comes as a tablet taken twice daily. To reduce stomach-related side effects, treatment starts with a gradual dose increase over the first several days using a starter pack. The dose is slowly raised until reaching the full maintenance dose. An extended-release version, Otezla XR, is also available for adults and children weighing at least 50 kg, which simplifies the dosing schedule. No lab tests or imaging are required before starting, and the medication doesn’t need to be refrigerated or injected, making it one of the more convenient options for managing these conditions long-term.