Systemic Treatments

Systemic treatments are any form of therapy that are delivered orally (in tablet or liquid form) or through injection or intravenous infusion. Systemic treatments work within the body, as opposed to topical treatments, which are applied directly to the skin.


(Brand Name: Otezla)


What it does / How it works

Apremilast is an immunosuppressant that comes in an oral tablet. Apremilast reduces the activity of phosphodiesterase 4 (PDE4), an enzyme that regulates inflammation in the skin and joints. Apremilast can help to clear plaques, reduce itch, improve nail psoriasis, and clear scalp psoriasis.


Time frame

Patients can expect to see symptom improvement within 4 months of starting treatment. The length of treatment may vary, and it is important to follow your doctor’s instructions carefully. 


Dosage Form

Apremilast is available as an oral tablet.


Dose and frequency

The usual maintenance dose is 30 mg twice a day. It may be started at a lower dose and titrated up over time to minimize the risk of side effects such as nausea, diarrhea, and stomach upset. 


Potential Side Effects

Common side effects include diarrhea, nausea, vomiting, headache, and upper respiratory tract infections (e.g. common cold). Rarely, this medication can decrease appetite, worsen depression, and cause weight loss.


How to manage side effects

Side effects such as nausea, diarrhea, and stomach upset usually resolve within the first month of treatment. The medication should be swallowed whole, with or without food. 


Monitoring and follow up

Your doctor may assess your kidney function before starting treatment as a lower dose may be required for patients with severe kidney impairment. Your doctor may also monitor your weight regularly during treatment. 

Cost considerations

Apremilast is not covered in most provinces. 

See public insurance for more details

Menter A, Gelfand J, Wu J, et al., Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies,Volume 82, Issue 6, P1445-1486, Published Feb 28, 2020. Available from: