TYK2 as a Therapeutic Target in Psoriasis

 

Jeffrey M. Cohen, MD, discussed TYK2 inhibitors, a new class of therapy being studied for the treatment of psoriasis, during his Fall Dermatology Week 2023 session, “Understanding TYK2 as a Therapeutic Target in the Management of Moderate to Severe Psoriasis.”

Inhibiting TYK2 prevents signaling from IL-12 and IL-23, which activates the Th17 cells that are central to psoriasis. Deucravacitnib, an oral TYK2 inhibitor that is US Food and Drug Administration approved for psoriasis, may be considered as a first-line therapy for patients who have not achieved an adequate response with other therapies, such as injectable biologics, or for those who do not want to use an injectable medication.

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.”

Turning the discussion toward undertreatment, Dr Cohen noted that barriers to care, including treatment costs, availability of dermatologists, insurance coverage for therapy, and safety concerns, do exist. 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 suggested.

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Reference

Cohen JM. Understanding TYK2 as a therapeutic target in the management of moderate to severe psoriasis. Presented at: Dermatology Week; September 20–23, 2023; Virtual.