Jayme Heim, MSN, FNP-BC, compares the efficacy, safety and dosing of 2 oral therapies, apremilast and deucravacitinib, for the treatment of plaque psoriasis.
Lauren Miller, MPAS, PA-C: Talk to me a little bit about how you compare apremilast and deucravacitinib. Right now, those are the 2 FDA approved molecules that are probably used the most. I think before deucravacitinib, apremilast was kind of our industry standard, if you will, for oral therapies for plaque psoriasis. Talk to me about the differences in the dosing. But you talked about tolerability and efficacy. Can you talk to me a little bit about that and what the differences are? And have you seen those clinically, not just in the in vitro studies, but have you seen that clinically?
Jayme Heim, MSN, FNP-BC: Absolutely. With apremilast, there's a titration pack and, this is off label, but lots of times we had to go ahead and titrate it up slower than even what the FDA approval was due to the fact that there were the side effects, the headache, the nausea, soreness, [and] the diarrhea that occurred with it. I found that I literally had to tell patients, you need to not drink your cup of coffee when you take your medication in the morning because of where it absorbs within the GI (gastrointestinal) tract. It has the same effect as a cup of coffee does in the morning. And so, helping to tell them these types of things, not to eat of the fatty meal, help to kind of decrease those effects. But I had to go ahead and prepare my patients for that. Also, the fact that it's a BID (2 times a day) dosing, once you get up to maintenance dosing, it's a BID dosing. Every time there's BID dosing, there's just less compliance. And so you have a medication that really, lots of times overall doesn't work as efficaciously.
With deucravacitinib,you have a medication that is once a day. You don't have to worry about titration. The other thing is you don't have that increased problem with headache, nausea and vomiting, and it doesn't have any drug to drug interaction. You don't have to worry about it if you have it with food, if you have it without food. And that's important. It just goes ahead in. It makes it much easier for patients. The tolerability is just so much better. Then when you look at the efficacy of the medication, even when you look at the point for one and put to the studies, you see that there is there is quite a bit of difference between the efficacy between these 2 molecules and overall here we look at the PASI (psoriasis area and severity index) 75, it's greater at PASI 75, and then a little bit lower for the PASI 90. But there is [also] PASI 90 data, which is very good. But I think that overall the tolerability is one thing that's very important for when you talk about both of these molecules as well as the efficacy.
Lauren Miller, MPAS, PA-C: And I agree with that. And I would say to speak to your point about the once-a-day vs the twice a day, at the end of the day, I think patients want to forget that they have a disease. They want to forget that they have psoriasis. And so, if you're taking something twice a day, that's 2 times a day that you're having to actively think about your disease. And that's if they're not having to think about it other times because of symptoms or whatnot. So once a day definitely allows that patient a little bit more freedom from their disease as well.
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