Concurrent Use of Simponi Aria and Otezla: Not Recommended Based on Current Evidence
The combination of Simponi Aria (golimumab) and Otezla (apremilast) is not supported by current guidelines and should generally be avoided, as there is no strong evidence supporting combined use of apremilast with other systemic therapies for psoriasis and psoriatic arthritis. 1
Guideline Position on Combination Therapy
The Joint American Academy of Dermatology-National Psoriasis Foundation guidelines explicitly state that "there is currently no strong evidence to support the combined use of apremilast with other systemic or phototherapy treatments for psoriasis." 1 This represents expert consensus that combination therapy with apremilast lacks adequate safety and efficacy data.
Evidence for Biologic Combinations
While biologics (like TNF inhibitors including golimumab) have been safely combined with methotrexate with demonstrated improved efficacy, this practice is increasingly undertaken specifically to reduce immunogenicity risk with monoclonal antibodies. 1 However, this evidence does not extend to apremilast combinations with biologics. 1
Limited Research Data
One small retrospective study of 22 patients found that apremilast could be added to existing biologic therapy without serious adverse events requiring discontinuation. 2 However, this single-center, open-label study is insufficient to establish safety or efficacy standards, particularly when:
- The study population was small and uncontrolled 2
- Six patients (27%) developed side effects including nausea, diarrhea, weight loss, and abdominal pain 2
- No efficacy data were provided to justify the added benefit of combination therapy 2
Clinical Approach: Sequential Rather Than Concurrent Therapy
The appropriate strategy is to use these medications sequentially, not concurrently. 1 When a patient fails one therapy:
- Switch to a different mechanism of action rather than adding medications 3, 4
- For TNF inhibitor failure (like Simponi Aria), consider switching to IL-17 inhibitors, IL-12/23 inhibitors, JAK inhibitors, or apremilast as monotherapy 4
- Apremilast is generally reserved for patients who cannot take or have failed biologics, not as an add-on therapy 5
Safety Concerns with Combination Therapy
Combining immunosuppressive therapies raises concerns about:
- Increased infection risk without established benefit 1
- Additive gastrointestinal side effects (apremilast causes diarrhea and nausea in a significant proportion of patients) 1, 6
- Lack of monitoring guidelines for this specific combination 1
- Potential for depression emergence or worsening with apremilast, which requires careful monitoring 1
Recommended Action
If the patient is not responding adequately to Simponi Aria alone, the evidence-based approach is to discontinue it and switch to an alternative monotherapy (such as an IL-17 inhibitor, IL-12/23 inhibitor, or apremilast), rather than adding apremilast to the existing biologic regimen. 1, 4