International Psoriasis Council

Advancing Knowledge. Enhancing Care.

Advancing Knowledge. Enhancing Care.

Commentary: Preclinical and Clinical Evidence for Suppression of Alcohol Intake by Apremilast

Johann Gudjonsson, MD, PhD

University of Michigan, Department of Dermatology

Ann Arbor, Michigan, United States

IPC Board Member

Bio

PUBLICATION

Preclinical and Clinical Evidence for Suppression of Alcohol Intake by Apremilast. Grigsby KB, Mangieri RA, Roberts AJ, et al. J Clin Invest. 2023 Mar 15;133(6):e159103. doi: 10.1172/JCI159103. PMID: 36656645; PMCID: PMC10014105.

Why this article was chosen

A host of factors is important to consider in the personalized treatment of psoriasis. It is advantageous if a treatment is effective in psoriasis and has beneficial effects on associated conditions. This recent literature publication has highlighted that apremilast, beyond its anti-psoriatic properties, positively impacts excessive alcohol consumption.

Commentary

A recently published article in the Journal of Clinical Investigation demonstrated that apremilast, a commonly used drug to treat psoriasis, is associated with reduced excessive alcohol drinking in models of stress-facilitated drinking and alcohol dependence.1 These findings may have major implications regarding the treatment of psoriasis, where there is a clear link between disease and alcohol use,2,3 and where apremilast is frequently used for treatment.4

Genetic variants in the PDE4B gene locus have been implicated with both alcohol and nicotine dependence in a genome-wide association study,5 and another PDE4 inhibitor, rolipram, has been shown to dose-dependently reduce self-administration of alcohol in a mouse model of alcohol consumption.6 PDE4 is expressed in the central nervous system, in the nucleus accumbens, a brain region associated with motivation and emotional processes.7 In the study highlighted here, the authors set out to determine if apremilast, a PD4 inhibitor, affects alcohol consumption in both mouse models of alcohol drinking and a double-blind, placebo-controlled proof-of-concept study in a moderate-size cohort composed of 24 women and 27 men, with a history of heavy drinking for an average ten years prior to the study. The findings demonstrated that apremilast reduced the number of drinks per day relative to the placebo and the probability of a heavy drinking day.1 The group further showed that apremilast alters the intrinsic excitability of nucleus accumbens-derived neurons expressing dopamine receptor D1, providing a mechanistic basis for its effect on alcohol consumption.1

Alcohol use disorder is frequent in patients with psoriasis and found in up to 8.6% of patients with psoriasis,2 and up to 23.8% of been reported to be high-risk drinkers.3 Furthermore, alcohol consumption has been shown to correlate with psoriasis severity.2 This also could relate to weight loss mechanisms in psoriasis, which principally relates to decreased abdominal subcutaneous fat, independent of its effect on psoriatic disease activity.8 Thus, the implications of this study on psoriasis management could be substantial and may help guide treatment in psoriasis patients with concomitant addiction problems. However, this will need to be confirmed and validated in future studies.

Alcohol use disorder is found in up to 8.6% of people with psoriasis and up to 23.8% of psoriasis patients are considered high risk.

References

  1. Preclinical and Clinical Evidence for Suppression of Alcohol Intake by Apremilast. Grigsby KB, Mangieri RA, Roberts AJ, et al. J Clin Invest. 2023 Mar 15;133(6):e159103. doi: 10.1172/JCI159103. PMID: 36656645; PMCID: PMC10014105.
  2. Alcohol Intake Measured by Phosphatidylethanol in Blood and the Lifetime Drinking History Interview are Correlated with the Extent of Psoriasis. Zou L, Lonne-Rahm SB, Helander A, Stokkeland K, Franck J, Nordlund K. Dermatology. 2015;230(4):375-80. doi: 10.1159/000380818. Epub 2015 Mar 21. PMID: 25823412.
  3. Addiction: An Underestimated Problem in Psoriasis Health Care. Zink A, Herrmann M, Fischer T, et al. J Eur Acad Dermatol Venereol. 2017 Aug;31(8):1308-1315. doi: 10.1111/jdv.14204. Epub 2017 Mar 31. PMID: 28281329.
  4. Psoriasis. Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker J. Lancet. 2021 Apr 3;397(10281):1301-1315. doi: 10.1016/S0140-6736(20)32549-6. PMID: 33812489.
  5. Genome-wide Association Study of Alcohol Consumption and Genetic Overlap with Other Health-related Traits in UK Biobank (N=112 117). Clarke TK, Adams MJ, Davies G, et al. Mol Psychiatry. 2017 Oct;22(10):1376-1384. doi: 10.1038/mp.2017.153. Epub 2017 Jul 25. PMID: 28937693; PMCID: PMC5622124.
  6. The Phosphodiesterase-4 (PDE4) Inhibitor Rolipram Decreases Ethanol Seeking and Consumption in Alcohol-preferring Fawn-Hooded Rats. Wen RT, Zhang M, Qin WJ, et al. Alcohol Clin Exp Res. 2012 Dec;36(12):2157-67. doi: 10.1111/j.1530-0277.2012.01845.x. Epub 2012 Jun 4. PMID: 22671516; PMCID: PMC4335658.
  7. The Nucleus Accumbens: A Comprehensive Review. Salgado S, Kaplitt MG. Stereotact Funct Neurosurg. 2015;93(2):75-93. doi: 10.1159/000368279. Epub 2015 Feb 18. PMID: 25720819.
  8. Effect of the Phosphodiesterase 4 Inhibitor Apremilast on Cardiometabolic Outcomes in Psoriatic Disease-results of the Immune Metabolic Associations in Psoriatic Arthritis Study. Ferguson LD, Cathcart S, Rimmer D, et al. Rheumatology (Oxford). 2022 Mar 2;61(3):1026-1034. doi: 10.1093/rheumatology/keab474. PMID: 34097014; PMCID: PMC8889283.

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