Exploring Novel TYK2-Targeted Therapies for Plaque Psoriasis - Episode 5
Thought leaders talk about blood monitoring protocols with deucravacitinib.
Linda Stein Gold, MD: In terms of getting a patient started on deucravacitinib, TB [tuberculosis] test?
Bruce Strober, MD, PhD: Yes. That is part of the label and it’s part of the label for all of our immunosuppressive drugs. So, a QuantiFERON Gold is what I get for every patient who walks in the door who has bad psoriasis.
Linda Stein Gold, MD: Then, in terms of laboratory monitoring, I’m just practically the ABCs of starting a patient on deucravacitinib, TB test, yes. You mentioned if somebody had significant liver disease, that would be an issue. But in terms of the label, we’ve seen with other JAK [Janus kinase] inhibitors that they do recommend kind of a series of baseline laboratory evaluations and then ongoing laboratory evaluations. It’s what I would say imperative just to make sure we’re keeping those patients safe. What is required with deucravacitinib, and then what do you personally do?
Bruce Strober, MD, PhD: Well, the only thing that’s required is the TB test. But it’s good medicine at baseline to get a fasting lipids, a hepatitis B and a hepatitis C serologies. And that’s actually in the label as a suggestion. Because there’s not really good data on what this particular medication might do with viral hepatitis. So I get those all at baseline, Quanti[FERON] Gold, [hepatitis] B, [hepatitis] C, fasting lipids, emphasis on triglycerides. But going forward, if the patient is healthy, no comorbidities that relate to the liver, I might not follow labs in that patient. I might simply say to the patient, well if you’re seeing your PCP yearly, you’re getting the right labs on an annual basis. And that to me is in line with clinical guidelines, which is kind of the term used in the label for deucravacitinib. If I know the patient is less healthy, obese maybe, has already the metabolic syndrome, insulin resistance, hypertension, I probably will get a follow up triglycerides 6 months in. But that’s about it. One thing that people always ask is, CPK [creatine phosphokinase] elevation does occur in people on deucravacitinib in some patients. It’s a rare issue, but it still happens. I don’t follow the CPK because in every instance it’s a clinically insignificant finding. The patients are asymptomatic and many times there’s other reasons for CPK elevation having nothing to do with the medication.
Linda Stein Gold, MD: You knowand you mentioned CPK elevations, and for those of us who do clinical trials on young healthy people, how often do you find an elevated level? It happens quite frequently.
Bruce Strober, MD, PhD: If someone’s exercising or exerting themselves, perhaps within a few hours of the blood draw, their CPK can be quite elevated, and it has no meaning. So to me, I don’t really want to do blood tests that while they get an abnormal result, I don’t know how to react to them, especially if the patient is clinically asymptomatic and feeling well.
Linda Stein Gold, MD: So do you get a baseline CPK?
Bruce Strober, MD, PhD: I do not.
Linda Stein Gold, MD: You do not. And it’s interesting because I do. It’s funny because people work a little bit differently and the only reason I do is just for that reason, because so many people tend to run high. You have somebody who’s a delivery person, they’re carrying heavy boxes, they work at a store where they’re loading and unloading, and often that’s where they live is on the higher range. So I just like to know, that way if it’s checked while they’re on drug, I know this is where you came to me.
Bruce Strober, MD, PhD: Totally OK. And that’s the thing with a drug like deucravacitinib, there is an art to its monitoring, and ultimately, as long as you’re not going too far and you’re overdoing it with monthly blood tests or even Q3 months. There’s sort of a style every practitioner has to have that they’re comfortable with. And really patients don’t mind blood tests. They actually feel you’re being careful when you’re using blood tests as part of the treatment approach.
Transcript edited for clarity