The authors present the results of a Delphi study conducted in Spain on the use of apremilast in psoriasis.1 Apremilast is a “small-molecule” oral phosphodiesterase 4 inhibitor that according to its summary of product characteristics is indicated for the treatment of psoriatic arthritis and chronic moderate to severe plaque psoriasis. The position of apremilast in the current arsenal of treatments for psoriasis has been influenced by several factors. First, its limited effectiveness compared with other alternatives; second its adverse effects, which in many cases require withdrawal of treatment due to poor tolerability; and last but not least, its cost, which is similar to that of the most effective biologic drugs available and higher than that of other biosimilars.

The authors, all experts in psoriasis, chose 5 points of interest to analyze using a Delphi questionnaire. After reviewing each point based on the existing literature, the panel concluded that apremilast might be a treatment option for patients with a different profile to that studied in the clinical trials. They highlight the need for a consensus-based definition of moderate psoriasis, which is where apremilast could possibly be positioned as a treatment option preceding biologic therapy. Finally, they stress the need for more scientific evidence from clinical trials and real-world studies to verify the opinions expressed in this study.