Advances & Unmet Needs in the Management of Plaque Psoriasis – Expert Advanced Practice Provider Perspectives - Episode 11
Experts in dermatology discuss the importance of deucravacitinib being an expansion of oral treatment modalities for plaque psoriasis, as well as the long-term data.
Alexa Hetzel, MS, PA-C: So, Andrea, what is the importance of this therapy being the first expansion in oral treatment modalities for the management of moderate to severe plaque psoriasis in the last 10 years?
Andrea Nguyen, PA-C, MS: It’s super exciting. We were talking about the history, the evolution, and understanding more about this disease and advancing of treatments. And I think deucravacitinib really has opened the door of what we have as Tyk2 inhibition. So, we have JAK inhibitors, as Jayme mentioned, and as far as how they regulate these proinflammatory cytokines and how deucravacitinib is involved with the regulation of the inflammatory pathway through the signaling of interleukin 23 and signaling of interleukin 17.
It’s really, really exciting, because many cytokines signal through JAK-STAT. Tyk2 is a very unique member of the JAK family. So, there are core members and then there’s Tyk2, and having this as being a new oral treatment modality through a very new way of inhibiting, basically Tyk2 in its inactive state, is really exciting from a scientific standpoint. And the clinical efficacy, as a clinician, is exciting [to see] for our patients with psoriasis. Deucravacitinib has a very high selectivity for Tyk2 over JAK1 and JAK3, I think it’s 100- to 200-fold. For JAK2, it’s over 3000-fold. So, it has a very high selectivity for Tyk2.
It is once-a-day dosing. It’s also an oral agent, so for our patients who don’t necessarily want injectables, we have another tool that we can offer them that, like Jayme was saying, does not require titration. Also, the tolerability profile of the medication has been shown to be favorable in clinical trials. This is something that really opens the door for conversation of now being able as clinicians to offer our patients different treatment options with specific aspects to each option vs historically, where it was: This is all we have, and if you don’t tolerate it, you don’t feel good or if your hair falls out, it is what it is. So, really, it’s been such a pleasure to see this coming to market and now be able to have another option for our patients.
Alexa Hetzel, MS, PA-C: So, Darren, speaking of clinical data, can you comment on the trial details and study results of the phase III studies of deucravacitinib leading to this FDA approval for use in patients with moderate to severe plaque psoriasis?
Darren West, MPAS, PA-C: Yes, it’s actually pretty impressive. To have an oral medication that can do this much work is pretty impressive. We have a lot of patients who will not tolerate injectables, so this makes an amazing option for them. When you look at the comparative data, they have comparisons in this data to other medications. If you look at it, I don’t have the exact numbers, but it’s incredible how it’s almost 30% better efficacy over other oral medications that we have currently. So, I like it a lot. I like how it works. I love the mechanism of action. I love the selectivity of it, the selective process without all of the other baggage. I think that was the biggest part of it, not having all of the other baggage associated with some of the other medications that have been recently approved for eczema, as we know with some of the JAKs. This dismisses that complete component of the system, and so it’s a lot easier to get this to our patients. The efficacy is seen in the literature in the phase III trials. I was impressed. I’m just very happy that I can see an oral medication actually do this with limited side effects. To be honest, I’m pretty pumped.
Alexa Hetzel, MS, PA-C: I love it. Do you feel the long-term data helps to increase providers’ and patients’ confidence in using deucravacitinib as therapy?
Darren West, MPAS, PA-C: Yeah. I think safety is in the mind in everybody who does a medication, and if we don’t have long-term safety data that can support it, then we’re going to have a harder time to do this. We’re lucky with deucravacitinib, because we have really good safety data, and it shows also very good efficacy, 2 things that you have when you’re trying to get a drug approved. So, absolutely, you have to see both of those aspects to get through and to have long-term success. Our providers are a little wary about doing things these days, and they need some of these results to feel comfortable about it, but I think they also need to get them on the medication to feel comfortable, as well.
Transcript edited for clarity