Which statement correctly describes apremilast, an oral systemic agent for plaque psoriasis and psoriatic arthritis?
- A It inhibits Janus kinase 1 and raises intracellular interferon signalling
- B It inhibits phosphodiesterase-4, increasing intracellular cAMP and lowering TNF-alpha, IL-17 and IL-23 production ✓
- C It blocks the p40 subunit of IL-12 and IL-23
- D It inhibits dihydroorotate dehydrogenase, blocking de novo pyrimidine synthesis
Correct answer: B. It inhibits phosphodiesterase-4, increasing intracellular cAMP and lowering TNF-alpha, IL-17 and IL-23 production
Explanation
Apremilast is a small-molecule phosphodiesterase-4 inhibitor. By preventing cAMP degradation it raises intracellular cAMP, which downregulates pro-inflammatory mediators including TNF-alpha, IL-17 and IL-23. Its characteristic adverse effects are diarrhoea, nausea, headache and weight loss, and it carries a warning regarding depression, so it is avoided in patients with a significant psychiatric history. Option D describes leflunomide, and option C describes ustekinumab.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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