Monitoring Patients on Deucravacitinib in Plaque Psoriasis

Alexa Hetzel, MS, PA-C: So Darren, how often is treatment or follow-up required with deucravacitinib therapy, and how does this compare with some of the other therapies that are out there for plaque psoriasis?

Darren West, MPAS, PA-C: I have limited experience with this medication, but I’m very hopeful that this is one of those medications I can put my patient on, follow-up in a couple months, and see how they’re doing. You do want to follow-up with these patients. We’re not going to just turn them loose. This medication reminds me a little bit of how the TNF [tumor necrosis factor]-alpha medications were 20 years ago. We just didn’t know what we were getting into. We didn’t have enough history. We didn’t have the data or the clinical experience to support the data. We were just always treading lightly on this ground. So with this medication, I would be similar. We’re going to write the medication, follow-up with them every 3 months, and just see how they’re doing.

I think medications that are oral, have fewer side effects, and require less monitoring are appealing. It’s appealing to all of us who have had a lot of history with these medications. Obviously, we’re going to follow similar guidelines—maybe not to the extent of the JAK [Janus kinase] inhibitors….Those of us who have patients on the JAK inhibitors, we’re very selective with our patients and we’re careful. But all-cause mortalities, lipids, [increased dichlorodiphenyltrichloroethane]—those are things that scare us, and we’re not seeing those types of things with this TYK2 [tyrosine kinase 2] drug and this TYK2 inhibitor. I would follow-up with them routinely, keep them going as much as we can, and hold their hand and educate them along the way.

However, the FDA approves this drug. When the FDA approves a medication, they’ve gone through the scrutiny of it. As advanced practice providers, we must trust our gut but also trust how these medications get approvals. We need to have some confidence in that. That’s how we have to approach this. Yes, follow up with and monitor your patients but also give them some space. Let them go and see them routinely, as much as we can, without overburdening them.

Thankfully, we don’t have to do what some of the disease-modifying antirheumatic drugs and other medications that we have, have required. That’s where it’s been a burden for a lot of us providers with certain medications, but I think we’re getting away from that. A year from now, if you ask me that same question…we’ll probably be writing it commonly and will have very little thought on how much we regulate and how much we monitor our patients.

Transcript edited for clarity.