April W. Armstrong, MD, MPH

approaching treatment in patients with plaque psoriasis who have a low BSA involvement, but with symptoms that present in difficult-to-treat areas.

Approaching Plaque Psoriasis Treatment in Difficult-to-Treat Areas

This is a video synopsis of a discussion involving April W. Armstrong, MD, MPH, Professor and Chief of Dermatology at UCLA, and Chair Emeritus of the Medical Board of the National Psoriasis Foundation. Dr. Armstrong specializes in psoriasis and atopic dermatitis.

Dr. Armstrong discusses treatment options for patients with low body surface area (BSA) involvement but challenging-to-treat areas such as the scalp, face, genitals, intertriginous areas, palms, and soles. While many systemic medications and biologics are approved for moderate-to-severe psoriasis with at least 10% BSA involvement, some payers make exceptions for difficult-to-treat areas with low BSA.

She notes that if payers do not approve biologics for such cases, deucravacitinib, an oral medication, is FDA-approved for patients with psoriasis, regardless of their BSA involvement. Additionally, apremilast, another oral medication, is an option approved for use in patients with plaque psoriasis, irrespective of BSA involvement, if they are deemed suitable candidates for systemic therapy.

Dr. Armstrong emphasizes the importance of considering patient characteristics and treatment preferences when selecting therapies for psoriasis, particularly for those with involvement in challenging areas. This tailored approach ensures patients receive appropriate treatment that addresses both their disease severity and affected body areas, enhancing treatment outcomes and patient satisfaction.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.

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An expert in dermatology provides insight on approaching treatment in patients with plaque psoriasis who have a low BSA involvement, but with symptoms that present in difficult-to-treat areas.

Dr April W. Armstrong comments on patient selection for oral systemic treatments for plaque psoriasis management.

Patient Selection for Plaque Psoriasis Oral Systemic Treatments

Dr. Armstrong discusses patient selection criteria for oral systemic treatments, noting that patients who prefer oral medications and have moderate-to-severe psoriasis are good candidates. She highlights the efficacy and tolerability of deucravacitinib, particularly for patients with palmoplantar involvement, where oral medications may outperform biologics.

She acknowledges the efficacy of deucravacitinib even in patients who have previously failed biologic therapies, possibly due to its targeting of the IL-23 pathway. Dr. Armstrong suggests considering switching such patients to IL-23 medications, either orally via deucravacitinib or through IL-23 biologics.

Emphasizing the multitude of treatment options available, Dr. Armstrong highlights deucravacitinib as an oral therapy with efficacy similar to first-generation biologics and a consistent safety profile. She notes that patients now have access to oral therapies that offer significant efficacy, comparable to biologics, providing a valuable treatment option for those who prefer oral medications.

April W. Armstrong, MD, MPH, shares her experience using oral systemic treatments in clinical practice for the management of plaque psoriasis.

Using Deucravacitinib in Clinical Practice for Plaque Psoriasis Management

Dr. Armstrong discusses her approach to prescribing deucravacitinib for patients with psoriasis who have not previously received systemic or biologic treatments. She highlights the medication's efficacy and safety profile, noting that patients find it well-tolerated with minimal gastrointestinal (GI) side effects, a rarity for oral medications. Clinical trial data corroborates this observation, showing similar GI complaints between deucravacitinib and placebo.

For patients who are suitable candidates for oral therapy, Dr. Armstrong recommends Deucravacitinib, confident in its ability to achieve clear or almost clear skin with proper patient selection. She notes that patients who initiate deucravacitinib tend to continue with the treatment.

In challenging cases, Dr. Armstrong combines deucravacitinib with biologic medications for added efficacy. This reflects a shift in treatment paradigms towards combining multiple therapies to achieve optimal outcomes, moving away from older options like methotrexate towards newer agents like deucravacitinib and apremilast.

Patients often express excitement and satisfaction with their clear skin when returning for follow-up visits, indicating a preference for deucravacitinib over other oral systemic medications. Dr. Armstrong observes significant changes in the field, emphasizing the decreasing use of methotrexate in favor of more modern options like deucravacitinib and apremilast as chronic oral prescriptions for psoriasis management.

laboratory requirements for initiating deucravacitinib in moderate-to-severe plaque psoriasis, the impact of deucravacitinib on the treatment landscape.

Impact of Deucravacitinib on Plaque Psoriasis Treatment Landscape

Dr. Armstrong outlines the minimal laboratory requirements for initiating treatment with deucravacitinib. At baseline, patients are typically assessed for tuberculosis (TB) status, often through QuantiFERON testing. Additionally, for patients with suspected or known liver disease, liver function tests (LFTs) or viral serologies may be recommended.

Regarding ongoing laboratory monitoring, there are currently no specific requirements for patients on deucravacitinib. Dr. Armstrong emphasizes that deucravacitinib, as a newer oral medication, has shown favorable results in both clinical trials and real-world experience. Its efficacy, especially in comparison to Apremilast, is notable, making it a leading option for patients with moderate to severe plaque psoriasis.

Dr. Armstrong acknowledges the array of treatment options available for patients, including highly effective injectable biologics. She discusses patient selection criteria, noting that deucravacitinib may be particularly suitable for patients with moderate to severe plaque psoriasis, leaning towards the moderate end of severity, who prefer the convenience of oral therapy.

For patients with more severe disease, Dr. Armstrong suggests considering biologic agents with robust efficacy. Overall, patient selection is crucial, and deucravacitinib is best suited for those with moderate to severe psoriasis, leaning towards the moderate end of severity, who prioritize the convenience of an oral medication.

An expert in dermatologic conditions examines laboratory requirements for initiating deucravacitinib in patients with moderate-to-severe plaque psoriasis and the impact of deucravacitinib on the treatment landscape.

April W. Armstrong, MD, MPH

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