Psoriatic Arthritis, Unmet Need, and Role of Oral Therapies, with Saakshi Khattri, MD

A growing interest has been observed among clinicians seeking out oral agents that can potentially delay the need for biologics in individuals living with psoriatic arthritis (PsA). In a new interview with the HCPLive team, a discussion was held regarding such drugs and deucravacitinib’s potential approval in patients with PsA after its recently-accepted supplemental New Drug Application (sNDA).1

This interview featured Saakshi Khattri, MD, MBBS, an assistant professor at the Icahn School of Medicine at Mount Sinai, a board-certified dermatologist, rheumatologist, internist, and 1 of the only triple-board-certified physicians in the US. Khattri was asked about her own clinical experiences regarding the key limitations associated with methotrexate and apremilast in the management of early PsA.

“You know, methotrexate being a conventional synthetic DMARD is certainly the go-to for a lot of our rheumatologists in the community, for PsA,” Khattri explained. “We have newer MOAs that have been approved in the last 5 or 7 years to treat PsA. I, in some ways, do disagree with using methotrexate first-line for PsA, just because I don't think the data is that robust. It doesn't really work for axial disease. It has some value in peripheral disease, but it's not approved for PsA…I would maybe add it as an adjunct. Certainly, if I'm using an anti-TNF, I'll add methotrexate, because we do know that methotrexate does decrease the possibility of an anti-TNF antibody production, and increase the longevity of the or the durability of a TNF antibody or a TNF inhibitor.”

Khattri also spoke about apremilast and its use in the management of early PsA, highlighting her own experiences.

“Apremlast is approved for psoriatic arthritis, but in my personal experience, I use it sort of for my early PsA,” Khattri said. “I know we've not quite defined very well what early PsA means, but I've used it for my patients where they have something, it's not clear because we don't have a test that diagnoses PsA. At the end of the day, it is a clinical diagnosis based on a history and a physical exam. I always tell my patients that if I'm diagnosing PsA on an X-ray, then you've had PSA for many years….I'll sort of use apremilast as a stepping stone in that scenario.”

Khattri was asked about whether deucravacitinib is shifting the conversation about oral agents for PsA, particularly in patients with milder joint disease or early PsA.

“I just want to hand out this caveat that it's not approved for PsA, it is in clinical trials,” Khattri said. “Hopefully, it'll get approval in the short-term future. If I have a patient who has questionable PsA, but sounds like they may have early disease, and they have minimal skin involvement or not enough skin involvement to warrant me thinking of an injectable biologic, I'll offer an oral small molecule, like apremilast or deucravacitinib. There is a head-to-head comparison between apremilast and deucravacitinib…They did have an apremilast active arm, and deucravacitinib did perform better than apremilast. So those are options that I talk with my patients about.”

Khattri was later asked, from a patient adherence and quality-of-life standpoint, how important the availability of a once-daily oral option like deucravacitinib as opposed to existing therapies.

“Patients do want an oral option, and certainly an oral option which is targeted to their disease state, as opposed to just a non-specific immune suppressant,” Khattri said. “[They want] an oral option that maybe simplifies use that is once a day and an oral option that doesn't need lab monitoring. Because at least in the dermatology space with deucravacitinib, we don't do routine lab monitoring other than a TB test that's needed before we get it approved. So that simplifies patient compliance, because you have a drug that is targeted towards the pathogenesis or pathways implicated in psoriatic arthritis. It is once a day, so that eases use and it doesn't need this constant lab monitoring.”

For any additional information on deucravacitinib and its use in patients with inflammatory conditions such as PsA, view Khattri’s full interview segment above.

The quotes used in this interview summary were edited for clarity.

References

1. Bristol Myers Squibb’s supplemental new drug application (sNDA) for sotyktu (deucravacitinib) for the treatment of adults with active psoriatic arthritis accepted for review across four regions globally. News release. BioSpace. July 21, 2025. https://www.biospace.com/press-releases/bristol-myers-squibbs-supplemental-new-drug-application-snda-for-sotyktu-deucravacitinib-for-the-treatment-of-adults-with-active-psoriatic-arthritis-accepted-for-review-across-four-regions-globally.