Novel TYK2 Inhibitors for Psoriasis

Psoriasis is undertreated in the United States, which leads to patient dissatisfaction, according to Jeffrey M. Cohen, MD, during his Dermatology Week 2023 session “Understanding TYK2 as a Therapeutic Target in the Management of Moderate to Severe Psoriasis.” Contributing factors to undertreatment include lack of access to care; patient concerns regarding adverse reactions, lab monitoring, and anxiety around injectable medications; and physician concerns regarding access, adverse reactions, and monitoring requirements. TYK2 inhibitors, a new class of therapy, are being studied for the treatment of psoriasis, with oral deucravacitnib US Food and Drug Administration approved for psoriasis at 6 mg a day. Because deucravacitinib is administered orally, it may be an option for patients who do not want to use an injectable medication.

Dr Cohen is an assistant professor of dermatology and biomedical informatics and data science and the director of the psoriasis treatment program at the Yale School of Medicine in New Haven, CT. The learning objectives of his presentation included describing the role of TYK2 in the pathophysiology and progression of psoriasis and associated implications for treatment; evaluating the latest data on the efficacy, safety, dosing, and administration of novel TYK2 inhibitors for patients with psoriasis; and implementing strategies to integrate TYK2 inhibitors and shared decision-making into psoriasis management.

Inhibiting TYK2 prevents signaling from IL-12 and IL-23, which activates the Th17 cells that are central to psoriasis. Deucravacitinib may be considered as a first-line therapy or for use in patients who have not achieved an adequate response with other therapies, such as injectable biologics. Dr Cohen added, “While this would be off label similar to what we have done with some of our other agents, we may be able to combine deucravacitinib, especially in acute flares on other medications. Use deucravacitinib for some period of time, try to get the flare under control, and then consider withdrawing. Or some patients may chronically need, for example, an injectable biologic and deucravacitinib together. This is likely safe and effective. We don’t have a lot of data on this yet, but we’ll see over time how this evolves in our treatment landscape.”

Barriers to care, including treatment costs, availability of dermatologists, insurance coverage for therapy, and safety concerns, do exist, so it is important to consider strategies to minimize these barriers while maximizing patient satisfaction and treatment adherence. To improve shared decision-making, Dr Cohen recommended using decision aids, conveying that the patient has a choice of therapy and describing the options including benefits and risks, and formulating the treatment plan with a focus on patient preferences and priorities. To improve adherence, he suggested following up with the patient in the first 3 to 7 days after starting treatment, utilizing alternative methods of communication such as telemedicine, building a therapeutic relationship that includes patient education, and linking the medication to a specific action or event such as “apply your cream when brushing your teeth.”

“Raising awareness of poor adherence among patients can help. Just making a comment that some people have trouble doing this. Some people don’t stick with it and that makes it so their skin doesn’t get better. Just saying that can actually sometimes help people put it on the radar and think more deeply about how they’re remaining adherent to their treatment,” Dr Cohen concluded.

For more meeting coverage, visit the Dermatology Week newsroom.

Maximize your experience by adding up to 90-days of on-demand access. Find the package that works for you. Upgrade here.

Reference

Cohen JM. Understanding TYK2 as a therapeutic target in the management of moderate to severe psoriasis. Presented at: Dermatology Week; May 3–6; Virtual.