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Raj Chovatiya, MD, PhD, discusses how oral TYK2 inhibitor zasocitinib may affect scalp, nail, and hand psoriasis, clearance speed, and once-daily dosing.
Zasocitinib, an investigational oral tyrosine kinase 2 (TYK2) inhibitor under US Food and Drug Administration (FDA) priority review for moderate to severe plaque psoriasis, produced high levels of skin clearance in hard-to-treat and high-impact regions of the body in phase 3 trials.¹˒²
Raj Chovatiya, MD, PhD, clinical associate professor of medicine at Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology + Immunology Research in Chicago, Illinois, spoke with the HCPLive team about the findings.
Chovatiya said special sites are challenging for two reasons. Drug penetration may be somewhat harder in these areas, raising hope the right targeted agent could deliver better efficacy. Individuals with involvement in such areas may also have limited disease extent despite feeling a burden comparable with individuals who have reported having head-to-toe plaque psoriasis.
He pointed to the scalp as part of the head and neck region patients present to others each day, and to hands used for handshakes and work. Nails and the genital region also carry undue burden, he noted. At Week 16, scalp-specific PGA scores of 0 or 1 reached 77% and 74% with zasocitinib in the two trials, and 71% and 69% of patients evaluated for palmoplantar involvement reached a hands and/or feet PGA of 0 or 1.¹
Chovatiya also highlighted an open scientific question: whether a pathogenic or target-related reason, such as the role of TYK2 in other immune signaling pathways, might help to explain differing clearance rates observed in these sites compared with biologics. The answer is not yet known, he noted.
About 70% of patients in the pair of phase 3 trials reached clear or almost clear skin by Week 16.¹ Chovatiya said data cuts so far suggest zasocitinib is not slow to act, and he expects patients to notice meaningful differences early. Responses also continue to improve beyond the primary period, he added, and Takeda reported clearance as early as Week 4, rising through Week 52.¹
Compared with earlier oral therapies, particularly first-generation TYK2 inhibitors, Chovatiya noted clinicians may be able to discuss a balance of speed, effectiveness, and durability.
How Could a Once-Daily Oral Option Change the Conversation About Visible Psoriasis?
For patients willing to move beyond a cream, Chovatiya said a once-daily pill resonates with how people have long thought about medications, such as antibiotics, analgesics, and cold remedies. Zasocitinib would be a chronic medication, he noted, but a daily pill remains an important part of how people view treatment.
Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Chovatiya previously reported serving as an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Argenx, ASLAN Pharmaceuticals, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, FIDE, Formation Bio, Galderma, Genentech, GSK, Incyte, LEO Pharma, L’Oréal, Nektar Therapeutics, Novartis, Opsidio, Pfizer Inc., Regeneron, RAPT, Sanofi, Sitryx, and UCB.
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