Lauren Miller, PA-C: Deucravacitinib and Merging Care of Psoriatic Patients

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The introduction of the TYK2 inhibitor is the latest advancement toward cross-specialty care with systemic agents.

Last September, the US Food and Drug Administration (FDA) approved deucravacitinib (SOTYKTU) for the treatment of patients with plaque psoriasis. The indication marked the end of a years-long spell in novel systemic drug approvals for the treatment of the chronic disease, and it introduced an agent with potential capability to treat psoriatic, rheumatic and gastric diseases by inhibiting the tyrosine-protein kinase 2 (TYK2) pathway.

In an interview with HCPLive during the Fall Clinical Dermatology 2023 Conference for PAs & NPs in Orlando, FL, this weekend, Lauren Miller, PA-C, of Southern Skies Dermatology, discussed the benefit of deucravacitinib in real-world practice, as well as its implicative benefit across multiple specialties.

“It has been almost a decade since the last systemic biologic agent for plaque psoriasis has been approved, and there’s been a ton of innovation in the biologic landscape—but not so much in the systemic landscape,” Miller said. “So this has been something that’s been really well-received and much-needed.”

Miller additionally noted the unique regulatory process behind TYK2 inhibitors—though they are technically “part of the JAK (Janus kinase inhibitor) family,” they did not require a similar boxed warning for use upon FDA approval.

“And I think it’s really great to have a diffgerent mechanism of action for patients that have plaque psoriasis,” Miller said. “We all know there’s not one drug that’s perfect for every single patient with psoriatic disease. I think TYK2 inhibition is something that’s novel.”

On the subject of the advanced practice practitioner’s role in managing patients with comorbid psoriatic disease—as they may one day with agents including deucravacitinib—Miller stressed that one size does not fit all.

“I feel comfortable treating patients with psoriatic disease such as psoriasis, but also psoriatic arthritis,” she said. “I was very blessed I had a supervising physician and mentor early on that taught me how to approach a patient that had both conditions, but I do realize there are some PAs and NPs that don’t feel quite confident to evaluate and treat those patients that have maybe more rheumatic issues going on.”

Deucravacitinib is additionally in development for the treatment of rheumatic disease like lupus nephritis, and even gastric conditions like inflammatory bowel disease. The convergence of these fields by way of inflammatory pathway-targeting drugs has resolved her and colleagues to embrace more patients with unique circumstances.

“I think now more than ever, advanced practice practitioners are really branching out to colleagues in their other specialties…but also, PAs and NPs are taking the initiative to dive into other disease states to try and learn so when we have patients that come in with multiple issues, that we feel confident in recognizing those and treating them as well,” Miller said.

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