The Emerging Oral & Topical Agents for Psoriasis

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Raj Chovatiya, MD, PhD, reviews the clinical progression of tapinarof and roflumilast cream headed into the 2022 Fall Clinical.

While the brief history of biologics for chronic dermatologic disease has prioritized injection administration, topical and oral agents for psoriasis in particular are trending—reflecting a merging of patient interests and clinician reverence for new options.

In an interview with HCPLive previewing discussions to be hosted at the 2022 Fall Clinical Dermatology Conference this week, Raj Chovatiya, MD, PhD, Director of the Center for Eczema and Itch in the department of dermatology at Northwestern University Feinberg School of Medicine, discussed the continued evolution of biologics for psoriasis.

“We’re at a dozen or more therapies with more on the way,” Chovatiya said. “But it doesn’t fill in every single gap.”

Chovatiya discussed the increasing patient interest in efficacious topical therapies that may expand beyond the capabilities of steroids and over-the-counter ointments, as well as the possibility of convenient oral options.

“I think really, we’ve managed to push levels of clearance so high with biologic therapies, there’s those out there who say, ‘Well, we don’t really need more psoriasis therapies, do we?’” Chovatiya said. “But we know this is an incredibly common inflammatory disease, by no means do we have everybody under control—so we probably need to figure out every possible avenue we can get to this in order to get people matched up to the right therapy.”

Lastly, Chovatiya highlighted a handful of such potential topical agents that will lead discussion at Fall Clinical this week, including roflumilast and tapinarof creams.

“The data for topical roflumilast is particularly interesting because even in on-label studies, it showed incredible improvement particularly in intertriginous areas and sensitive sites that are oftentimes really limited for our patients when we’re using topical therapies and are worried about potencies,” he explained.

Regarding tapinarof cream, Chovatiya highlighted its function as an AHR receptor modulating agent—a rarity in dermatology.

“Particularly what’s going to be highlighted is this idea of people who get clear then stay off therapy—they seemingly can have longer responses of staying clear as well,” he said. “This seems to be something that’s being uniquely investigated with this molecule as well.”