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Efficacy of Tapinarof in Plaque Psoriasis


James Q. Del Rosso, DO, and Dawn L. Sammons, DO, FAOCD, FAAD, review the efficacy of a new topical agent in the treatment of plaque psoriasis, tapinarof, highlighting the remittive data.

James Q. Del Rosso, DO: Dawn, with regard to tapinarof, we’ve heard some discussion of tapinarof. Did anything specific in the data with the clinical studies stand out to you to support your use of that in practice? Where you say it looked really in the studies, I’m going to give that a shot in clinical practice.

Dawn L. Sammons, DO, FAOCD, FAAD: Ben alluded to the fact that I love that you get that marriage of all those factors: efficacy, safety, tolerability, and of course access. But the thing that makes it unique is that it has a remittive effect. We’ve never had a drug, especially topically, that has that, let alone in its package insert. Now we have a drug like tapinarof with data that show that a patient can utilize and stop using it once the patient is clear. They can have maintenance of that clearance in some cases for 4 months or longer. That’s phenomenal. Why? Because it’s what our patients do anyway. When we’re using topical steroids, they’re cheap and easy. Maybe there are concerns, but we’ve done it for years. I’ve been in practice long enough that I’ve written my fair share of steroids for psoriasis. But the minute they stop using it, it rapidly starts to come back. For patients, it becomes a chronic cycle of applying therapy.

James Q. Del Rosso, DO: It’s a roller coaster.

Dawn L. Sammons, DO, FAOCD, FAAD: Yes, and they get burned out on it. It’s nice for patients because they can treat. In a relatively short period of time, we can look at them seeing significant benefit and then clearance for a large percentage of patients. Then they can go off therapy, so that remittive effect is something we haven’t seen before.

James Q. Del Rosso, DO: We have to be careful how we define remittive effect because other agents have talked about remittive effects. This is the first product that I’m aware of that allowed patients to treat until completely clear. Then they’d be off it until it came back in a mild fashion, and then they could restart it. Typically, we go to clear or almost clear. Patients don’t want to be almost clear; they want to be clear. That’s the first time that’s been done. The remittive effect was about 4 months on average. Some went longer.

Dawn L. Sammons, DO, FAOCD, FAAD: That’s what I was going to say. Some patients were shorter than that, but others went much longer than that. That’s what our patients want. They want to have something and to be able to do that with a topical, especially for patients who are utilizing it. I’m utilizing it in combination. That’s not part of the package insert, but I’m using it in combination with my biologic patients. They have a flare and treat until they’re clear. We don’t have data on what that looks like. Down the road, we’ll eventually have some real-world data to show what that looks like.

James Q. Del Rosso, DO: The package insert says that it’s a once-daily treatment for adult patients with plaque psoriasis of any severity. That’s the on-label use. It doesn’t say anywhere that you can or can’t use it with other therapies. It wasn’t, but you don’t have to be on label on your practice. You’re the clinician.

Dawn L. Sammons, DO, FAOCD, FAAD: That’s the best part about being a dermatologist.

James Q. Del Rosso, DO: The best part of being a physician is that you’re not bound by that.

Transcript edited for clarity

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