Systemic non-biological (immunomodulatory) agents are methotrexate, ciclosporin and acitretin. Each requires careful monitoring to minimise the risk of harmful side effects. Apremilast (Otezla from Celgene) €“ the first of a new class of systemic non-biological drugs €“ was approved in Europe in January 2015.
The dose has to be titrated up over the first week to minimise the occurrence of GI side-effects. Unlike the agents described above, apremilast does not require intensive monitoring for toxicity.