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Expert Perspectives on the Management of Plaque Psoriasis - Episode 7

Recent Approval of Deucravacitinib for Patients With Plaque Psoriasis

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Jerry Bagel, MD, MS, and Alexa Hetzel, MS, PA-C, discuss the safety and efficacy of deucravacitinib in patients with plaque psoriasis.

Alexa Hetzel, MS, PA-C: Knowing that we have all of these biologic options, with deucravacitinib recently being approved, which is a tyrosine kinase inhibitor for the treatment of plaque psoriasis, how do you feel like this mechanism of action is different? How do you think it is going to fold into how we treat patients?

Jerry Bagel, MD, MS: Deucravacitinib is an interesting molecule. It’s a TYK2 [tyrosine kinase 2] inhibitor, and TYK2 is a type of JAK inhibitor, but it differs in its mechanism of action significantly because the JAK molecule has 2 components: the regulatory component and the catalytic component. It doesn’t bind the catalytic component like all of the other JAKs, because when you bind the catalytic component of one JAK, you probably bind the catalytic component of all of the other JAKs, and then you get the adverse effects of all of those JAKs. By binding just the TYK2 inhibitor of the regulatory component, you’re much more specific, and you don’t have the downstream adverse event profile. Yet you do stop this TYK2 from working, and therefore, it stops the downstream induction of the DNA from producing proinflammatory molecules. It’s an interesting molecule, and the data show that it’s really safe. The 52-week data show that it works, with a PASI 75 [75%improvement in the Psoriasis Area and Severity Index] of about 65%. I’d say it’s comparable in efficacy to Stelara or Humira, in an oral, once-a-day, 6-mg dosage. The quality of life outcomes have been very strong in regard to decreasing Dermatology Life Quality Index. The index goes from 0 to 30, and most of the people in the clinical trials had about a 14, and this brought it down to about a 4. Many people had 0 or 1, which means that they had no impact on their quality life after 16 weeks. It’ll be interesting to see.

Alexa Hetzel, MS, PA-C: What do you think about head-to-head data compared to Otezla?

Jerry Bagel, MD, MS: They did a study that we worked on in our office as well, and we found that deucravacitinib had a PASI 75 of about 60%, and Otezla was about 35%, which was what was seen in the clinical trials with Otezla. But there were not any of the adverse events that you saw with Otezla, nonserious but annoying adverse events, like nausea, diarrhea, headache, or weight loss.

Alexa Hetzel, MS, PA-C: Everybody likes that one.

Jerry Bagel, MD, MS: Everybody likes the weight loss. They didn’t have that, and they didn’t have the thrombophlebitis or cardiac events that one would see with some of the other JAK inhibitors.

Transcript Edited for Clarity