Vascular Inflammation in Psoriasis - Apremilast

The primary objectives of this study are to determine the effect of apremilast on aortic
vascular inflammation, cardiometabolic biomarkers and body composition in patients with
moderate-severe psoriasis. FDG-PET/CT will be used to assess vascular inflammation, with
multi-volumetric product, tissue-to-background ratio and total atherosclerotic burden, and
body composition via volumetric quantification. This is a year-long, single arm, open label
study.

Inclusion Criteria:

- Males and females 18 years of age and older.

- Clinical diagnosis of psoriasis for at least 6 months as determined by medical history
interview and confirmation of diagnosis through physical examination by Investigator.

- Stable plaque psoriasis for at least 2 months before screening and at baseline (Week
0) as determined by medical history interview.

- Moderate to severe psoriasis defined by ≥ 10 percent Body Surface Area (BSA)
involvement at the baseline (Week 0) visit.

- PASI score of ≥ 12 at the Baseline (Week 0) visit.

- Participant is a candidate for systemic therapy and has active psoriasis despite prior
treatment with topical agents.

- Women are eligible to participate in the study if they meet one of the following
criteria:

- Females of childbearing potential (FCBP) must have a negative pregnancy test at
screening and baseline. Women of childbearing potential must undergo periodic
pregnancy testing during the study and agree to use at least one of the following
methods of contraception throughout the study duration and for at least 28 days after
taking the last dose of investigational product:

- Oral contraceptives

- Transdermal contraceptives

- Injectable or implantable methods

- Intrauterine devices

- Vaginal ring

- Vasectomized partner

- Barrier methods (Male or female condom (latex condom or non-latex condom NOT made out
of natural [animal] membrane [for example, polyurethane]; PLUS one additional barrier
method: (a) diaphragm with spermicide; (b) cervical cap with spermicide; or (c)
contraceptive sponge with spermicide.);

- Women who are postmenopausal (for at least one year), sterile, or hysterectomized;

- Women who have undergone tubal ligation will be required to undergo periodic pregnancy
testing during the duration of the study

- Sexual abstinence, defined as total abstinence from sexual intercourse, is considered
an adequate form of contraception. (Agreement to comply with sexual abstinence must be
recorded in the source document).

- Participants using oral or parenteral forms of contraceptives must have been using
these methods for at least 90 days prior to baseline visit.

- Men (including those who have had a vasectomy), who engage in activity in which
conception is possible, are eligible to participate if they:

- Use barrier contraception (male latex condom or non-latex condom NOT made out of
natural [animal] membrane [for example, polyurethane]) while on investigational
product and for at least 28 days after the last dose of investigational product.

- Participant is judged to be in good general health as determined by the Principal
Investigator based upon the results of medical history, laboratory profile and
physical examination performed at screening.

Exclusion Criteria:

- Prior treatment with apremilast.

- Diagnosis of erythrodermic psoriasis, generalized or localized pustular psoriasis,
medication-induced or medication-exacerbated psoriasis, or new onset guttate
psoriasis.

- Diagnosis of other active skin diseases or skin infections (bacterial, fungal, or
viral) that may interfere with evaluation of psoriasis.

- Cannot avoid topical prescription medications for psoriasis for at least 14 days prior
to the baseline visit (week 0) and during the study, with the exception of
hydrocortisone 2.5% for the face and intertriginous areas.

- Cannot avoid UVB phototherapy or Excimer laser for at least 14 days prior to the
Baseline (Week 0) visit and during the study.

- Cannot avoid psoralen-UVA phototherapy for at least 30 days prior to the Baseline
(Week 0) visit and during the study.

- Use of systemic therapies for the treatment of psoriasis, or systemic therapies known
to improve psoriasis, during the study:

- Systemic therapies must be discontinued at least 30 days prior to the Baseline (Week
0) visit except for biologics.

- All biologics, except IL-12/IL-23 antagonists, must be discontinued for at least 90
days prior to Baseline (Week 0).

- Any IL-12/IL-23 antagonist (e.g., ustekinumab, briakinumab) must be discontinued for
at least 180 days prior to Baseline (Week 0).

- Investigational agents must be discontinued at least 30 days or 5 half-lives
(whichever is longer) prior to the Baseline (Week 0) visit.

- Participant is ≥ 300lbs

- Participant is taking or requires oral or injectable corticosteroids during the study.
Inhaled corticosteroids for stable medical conditions are allowed.

- Participant is taking a medication that interferes with metabolism of apremilast,
including but not limited to rifampin, phenobarbital, carbamazepine, phenytoin

- Poorly controlled medical condition, such as unstable ischemic heart disease,
cerebrovascular accident or myocardial infarction within the prior 6 months,
psychiatric disease requiring frequent hospitalization, and any other condition,
which, in the opinion of the Investigator, would put the participant at risk by
participation in the study.

- Prior history of suicide attempt at any time in the participant's life time prior to
screening or randomization, or major psychiatric illness requiring hospitalization
within the last 3 years.

- Uncontrolled hypertension, with measured systolic blood pressure >180 mmHg or
diastolic blood pressure >95 mmHg

- Participant has infection or risk factors for severe infections, for example

- Positive serology or known history of HIV, hepatitis B or C, or other severe,
recurrent, or persistent infections;

- Excessive immunosuppression or other factors associated with it, including human
immunodeficiency virus infection;

- Active tuberculosis (TB) disease;

- Any other significant infection requiring hospitalization or intravenous (IV)
antibiotics in the 30 days prior to baseline;

- Infection requiring treatment with oral or parenteral (other than IV) antibiotics
within 14 days prior to baseline;

- Participant has received vaccination with a live viral agent within 30 days prior to
screening or will require a live vaccination during study participation including up
to 30 days after the last dose of study drug.

- Participant has history of hematological or solid malignancy other than successfully
treated basal cell carcinoma, non-metastatic cutaneous squamous cell carcinoma or
cervical intraepithelial neoplasia or carcinoma in situ of cervix with no evidence of
recurrence within the previous 5 years.

- Female participant who is pregnant or breast-feeding or considering becoming pregnant
during the study.

- Screening clinical laboratory analyses showing any of the following abnormal results:

- White blood cell (WBC) count <3.0 x 109/L. (Subject can be included if WBC count is
<3.0 x 109/L and absolute neutrophil count (ANC) is >1000 cells / mm3.)

- WBC count > 15 x 109/L;

- Hemoglobin (Hgb) < 9.0 x 109/L;

- Platelet count < 100 x 109/L;

- Serum creatinine >1.5 mg/dL ;

- Serum aspartate transaminase or alanine transaminase >2.0 upper limits of normal

- Recent history of substance abuse or psychiatric illness that could preclude
compliance with the protocol.

- History of substance abuse within 365 days of screening visit.

- Alcohol use of more than 14 drinks per week within 14 days of the baseline visit

- If subject is on cholesterol-lowering medication (e.g. statin), dose and form of
medication must be stable for 90 days prior to week 0 and remain stable throughout the
duration of the study.