Otezla for Weight Loss: Uses, Dosage, Side Effects, Efficacy

Fernando Mariz

Medically reviewed by

Fernando Mariz

Fernando Mariz

About

Dr. Fernando Mariz is a Manhattan-based doctor focused on contemporary medicine. He trained in gynecology and is a specialist in preventative care, pelvic pain, abnormal uterine bleeding, and sonography. His philosophy is to establish a partnership with his patients with their goals in mind, to achieve the best possible outcomes. Dr. Mariz completed his undergraduate studies with a Bachelor of Science in Biology and Chemistry at the Florida State University, followed by his Medical Degree at the Poznan University of Medical Sciences. He went on to do a residency in Obstetrics and Gynecology at the University of Toledo Medical Center. In residency, Dr. Mariz took special interest in minimally invasive surgery and sonography. He taught co-residents and medical students, was awarded 'Teacher of the Year', and even honorarily inducted into the American Association for Gynecologic Laparoscopists.

Credentials

Medical Advisory Board Member At:

• Nu Image Medical

Written by our editorial team.

Last Edited 1 year ago · 5 min read

Fat elimination is typically supported by products that reduce calorie intake, promote physical activity and accelerate metabolisms. However, there are rare occasions where treatment from a completely different class of medication comes in to fight the battle of the bulge. One of the medicines that have been moving into the dual-use side is Otezla. Made by Amgen Inc, Otezla belongs to the PDE5 inhibitor category, a class of drugs more commonly known for its ability to combat erectile dysfunction rather than fat stores.

Below we take a look at the different properties to better understand its function as a weight loss aid:

Basic Overview of Otezla

Otezla is a prescription treatment designed to manage symptoms of psoriatic arthritis, moderate to severe plaque psoriasis, and oral ulcers associated with Behçet's disease. The product essentially reduces inflammation in the body to lower the intensity and frequency of symptoms linked to the diseases mentioned. In doing so, the medication successfully manages and treats these conditions. The driving force behind its abilities is the active ingredient called apremilast. 

This ingredient is known for its potency and inhibitory effect on the PDE5 enzyme, which essentially helps with the product's anti-inflammatory properties. According to PubMed evidence, Otezla has an excellent safety and efficacy profile. This means it can be used safely used by a wide range of users and in combination treatment plans. The evidence also demonstrates the product's flexible and reliable nature, which brings us to possible secondary uses of Otezla. Although Otezla is primarily used to treat skin and blood vessel inflammation, there are claims that the product helps with weight loss. 

Otezla Uses 

Medicines are essentially multiple compounds fused together to form a solution that cures, halts, manages, or prevents diseases/conditions. In the past, patients were under the impression that treatments were only created to treat/manage a single condition. However, in recent years, research has proved otherwise. Treatments like Otezla can be used to manage the symptoms of multiple conditions. 

Let's take a better look at Otezla's uses below:

• Plaque psoriasis 

This common type of psoriasis causes the formation of dry, itchy, raised skin patches (plaques) covered with scales. It typically forms on the knees, elbows, lower back, and scalp. 

• Active psoriatic arthritis

This inflammatory condition causes stiffness, swelling, and joint pain. 

• Oral ulcers associated with Behçet's Disease

Raised, round lesions in the mouth that turn into painful ulcers. 

The tablet works to manage/treat these conditions by controlling the inflammatory actions within cells that affect the level of inflammation associated with each ailment. Otezla has been clinically proven to control and manage symptoms of the above conditions. Most of these uses have been known to the mainstream market for many years. However, Otezla's use for weight loss is quite a recent claim and not extensively backed.  

Otezla and Weight Loss

Otezla's primary purpose is quite well-known in the world of medicine. The product is typically used as a first-line treatment for acute and chronic conditions that deal with inflammation and the associated pain that comes with these conditions. Several studies demonstrate its effectiveness in its primary role/capacity, showcasing its effect on swelling and inflammation. Other beneficial effects were also noted, one of the most intriguing being weight loss. 

We look at evidence from a JAMA Network study that identified weight loss as one of Otezla's effects. The non-randomized clinical trial took place for 52 weeks and involved 70 adults with moderate to severe psoriasis. The evidence showed:

• Otezla had a neutral association with aortic vascular inflammation (artery inflammation) but a beneficial association with several cardiometabolic biomarkers (weight, heart disease risk, blood pressure/sugar, cholesterol). 

• The use of the product was associated with a 5%-6% reduction in subcutaneous and visceral fat. The loss occurred at 16 weeks of treatment and persisted to the end of the 52 weeks.

Although this is viewed as mild weight loss and deemed insignificant in general, it is meaningful from a clinical stance, especially considering the product is not a weight loss accelerator but manages to target/eliminate both subcutaneous and visceral fat. Subcutaneous fat is stored under the skin, found in arms/legs, and visceral fat wraps around the abdominal organs—liver, stomach, and intestines. 

According to Harvard data, visceral fat can cause health issues such as:

• Stroke

• Breast cancer

• Colorectal cancer

• Alzheimer's disease

• High blood pressure

• Insulin resistance and diabetes

• Heart attack and heart disease

The mild weight loss provided by Otezla can lower the risk of individuals developing the above. The decrease in fat ratios can provide cardioprotective effects, which makes up for the fact that the product had no effect on artery inflammation in the study. 

How Does Otezla Cause Weight Loss?

As a PDE5 inhibitor, it's hard to decipher how Otezla works as a weight-loss agent. According to experts, its fat-eliminating capabilities are a side effect that unconsciously plays out throughout Otezla treatment plans. Patients who use Otezla typically experience a loss of appetite, which in turn, reduces calorie intake. In some cases, this causes gradual weight loss, while no changes are noted in others.

The weight loss often depends on users' biological makeup, which is why Otezla weight loss cannot be guaranteed. After analyzing several studies and reviews, we found that weight loss can occur in 10% to 12% of people who use the drug. A loss of 5% to 10% of total body weight is most common. However, there have been cases where people have had a greater weight loss of more than 10% of their total body weight.

Adversities such as diarrhea, nausea, and vomiting can all contribute to weight loss but may only be transient. 

Otezla's Efficacy and Safety for Weight Loss

According to data from a real-world study from PubMed, Otezla has an excellent safety and efficacy profile when used for its primary purpose—psoriasis. The evidence suggests that the product's positive effect on psoriasis comes with minimal adverse events and maximum results. There are little to no risks linked to long-term use, making it ideal for acute or chronic treatment. But does this profile remain steady when weight loss is also experienced? 

Below we look at evidence from clinical trials which dissect the safety and efficacy of Otezla in situations where weight loss was noted along with psoriasis improvement: 

• The trial, which consisted of 1250 patients total, saw 1 in 5 psoriasis patients with more than a 5% weight reduction. This fat loss percentage proves the drug's efficacy/effectiveness in weight loss.

• The patients with this significant weight loss did not experience any increased incidence of GI adverse events (common side effects). Except for a short duration in the first 2 weeks. This demonstrates the drug's safety in weight loss.

• The weight loss linked to Otezla use was progressive. Patients continued to lose weight during the trial until the last week when weight loss plateaued.

In a psoriasis population where the mean baseline weight is greater than 90 kg, this weight loss comes as a benefit that can greatly improve one's health, mostly because the risk of cardiovascular issues is increased in those with psoriasis. 

Recommended Dosage

Otezla is available in multiple strengths—10mg, 20mg, and 30mg which provide professionals with the flexibility they need to prescribe exact strengths for different patients' needs. Although the tablet is available in exact strengths to accommodate these needs, all users must start on the same dosing plan—standard dosage plan/instruction. There is no specific dosage for weight loss alone. 

Otezla dosages work on a titration schedule, meaning that users need to start on the lowest effective dose and move up to higher doses each day. The titration schedule is in place to reduce the intensity and frequency of gastrointestinal symptoms that may occur at the beginning of treatment.

Below we look at the Otezla 5-day titration schedule:

After day 5, a recommended maintenance dosage of 30 mg twice daily must be followed. Each pill must be swallowed whole with a glass of water. Each dose can be administered with or without meals. 

Otezla Side Effects

Side effects are adverse effects that can present themselves during any treatment plan. They usually cause mild to severe discomfort and are often used to determine treatment continuation. In essence, the benefit of using a treatment must outweigh possible risks. Otezla is a classic example of a treatment whose benefits outweigh possible risks. 

The drug represents a significant advance in medicine as it's the first FDA-approved for psoriatic arthritis and psoriasis. At the time this article was initially published, it was the only drug available on the market that required no tuberculosis screening or laboratory monitoring. Nevertheless, it's important to acknowledge the possible side effects that might occur. 

Common side effects include:

• Nausea

• Diarrhea

• Back pain

• Vomiting

• Weight loss

• Stomach pain

• Tension headache

• Decreased appetite

• Fatigue (lack of energy)

• Insomnia (trouble sleeping)

• Common cold/flu symptoms

These adverse effects do not occur in every patient and are typically transient with a mild expression. Most users use at-home remedies to decrease their intensity or duration.

More serious side effects include:

• Depression

• Allergic reaction

• Thoughts of suicide

• Severe diarrhea, nausea, or vomiting

According to data, serious adverse effects such as allergic reactions haven't been recorded in clinical trials involving Otezla, which re-enforces its safety profile. 

Otezla Interaction and Contraindications 

Interactions and contraindications dictate treatment use. They are essentially a list of drugs and conditions that are incompatible with each other. Interactions refer to the drugs/medications that cannot be used together, while contraindications are conditions that do not allow the use of certain medications. Below we look at the interactions and contraindications that come with Otezla.  

Otezla should not be taken with the following medicines:

• Alpha-blockers

• HIV protease inhibitors 

• Guanylate cyclase stimulators 

• Nitrates and nitric oxide donors 

• Other PDE5 inhibitors–ED treatments 

• Natural supplements and treatments

• Medicines that are used to regulate heartbeats 

• Medication used to control high or low blood pressure 

In addition to the medicines mentioned above, patients should not consume grapefruit or grapefruit-infused products with Otezla. 

Otezla should not be used if you have the following:

• Stroke

• Diabetes 

• Hyperlipidemia 

• Stomach ulcers 

• Pulmonary venous

• Retinal disorders

• Blood vessel issues 

• Retinitis pigmentosa 

• Hypertension or hypotension 

• Bleeding disorders or leukemia, multiple myeloma 

• Coronary artery disease, heart failure, heart attack

• Severe chest pain (angina), unstable or irregular heartbeat

Patients with the below conditions should use the tablet with caution:

• Severe/liver kidney disease —Patients who suffer from this condition must opt for titration treatment schedules that stop at standard low doses. 

• Sickle-cell anemia (blood disorder)—Frequent high-strength doses must be limited in these patients. 

• Occlusive disease or PVOD—Patients with this condition must lower their dosage strength and frequency.

Using Otezla with any of the conflicting medications above or any of the conditions stated above can induce undesirable effects, which can hinder the possibility of successful outcomes. Adherence to the above will ensure patients have a positive treatment experience, free of adversities. 

Bottom Line 

The medical industry is growing rapidly as modern medicine advances and researchers delve deeper into the capabilities of pharmaceutical drugs. There is no denying that treatments like Otezla produce potent/reliable effects that can easily manage psoriasis and associated conditions. However, its reliability does waver when it comes to weight loss. Yes, the treatment may cause weight loss, but this is only seen in situations where the medication is treating a primary cause— plaque psoriasis, psoriatic arthritis, and oral ulcers. This means that it should not be used independently to induce fat loss. The fat loss effects the drug produces are essentially a side effect of Otezla use, which means it will not occur in every user and can be fleeting at best—the possibility of weight loss cannot be determined. We conclude that Otezla cannot be considered for weight loss. 

6 Sources 

https://pubmed.ncbi.nlm.nih.gov/29388335/

https://jamanetwork.com/journals/jamadermatology/fullarticle/2796165?guestAccessKey=582c0142-2a92-4c13-8326-0a3e986944a1&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=092122

https://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/abdominal-obesity/

https://pubmed.ncbi.nlm.nih.gov/29388335/

https://www.mdedge.com/rheumatology/article/87968/psoriasis/apremilast-improves-psoriasis-side-order-weight-loss?reg=1

https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/205437s011lbl.pdf

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your physician about the risks and benefits of any treatment. Nu Image Medical may not offer the medications or services mentioned in this article.