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Identifying the Remittive Effect in PP Patients


Lauren Miller, MPAS, and Tj Chao, MPAS, discuss the clinical importance of the remittive effect in plaque psoriasis (PP) patients.


Lauren Miller, MPAS, PA-C: Remittive effect, in case somebody doesn’t know what that is, is when a patient gets to clear. In their trials, they looked at PGA [Physician Global Assessment], and that’s what roflumilast did as well. [The patients had] a PGA of 0 and then stopped therapy. Then they waited until they got to a PGA of 2 and then restarted therapy. This mimics real life. Patients typically are going to use it until [they’re better], then they’re going to stop it. When they start to flare, they it again. That’s essentially what remittive effect is. They were able to stop. Patients don’t want to be reminded that they have a disease. Having that remittive effect—some would call it a drug holiday.

[Let’s say you] have a disease where you have to apply medication every day, once or twice a day, and if you stop it, the disease is going to come back. [Imagine going from that] to being able to go 4 [months]. Some patients went up to 6 months that they didn’t have to apply their drug. That means when they go on vacation, they don’t have to take it with them. Depending on what work they do, they don’t have to have bags of cream in their passenger seat while they’re traveling. When you have that conversation with patients, do you talk to them about that? Do they think it’s a big deal?

TJ Chao, MPAS, PA-C: Absolutely. A lot of these patients have been using topical steroids before using this, so they know what goes on with that. It’s as if they can’t leave home without a topical steroid. They have to carry it with them. If they go away on a trip, they’re definitely going to take it with them. You get a benefit from the topical steroid and then within days the disease potentially starts to come back. It’s very frustrating for patients. It’s exciting to have an option where you can get patients clearer for longer.

Lauren Miller, MPAS, PA-C: Yes,100%. This is something we’ve never had the ability to do before. I specifically talk about that with patients. I see patients’ eyes light up because by the time they get to me, most of them have already done topical steroids or other [medications], and they’ve never been able to stop a therapy. To give them that information and say, “Odds are you’re going to have the chance to stop this and go some period of time before you’re going to have to restart,” which is what we think of with systemics and biologics, gives them some hope and makes them happy about that.

TJ Chao, MPAS, PA-C: When I’m talking about tapinarof with patients, I make a correlation. I’m a little older than you, so I remember a time when we couldn’t pay a bill at a stoplight on our phone. The thought of being able to do that never crossed my mind when I was growing up. It’s the same thing with what we’re seeing with these new agents. The ability with tapinarof to get patients to remission is a concept that never crossed my mind as being possible. Just like the thought of paying a bill from a phone in the middle of nowhere, I never thought that would be possible either.

Lauren Miller, MPAS, PA-C: Some of the newer providers coming out of PA [physician assistant] school or NP [nurse practitioner] school have no idea what it was like to practice 15 or 20 years ago.

TJ Chao, MPAS, PA-C: It’s easy to take it for granted.

Lauren Miller, MPAS, PA-C: We didn’t have many treatment options. Some of the older providers would talk about coal tar. Imagine how they’re thinking now that we have this ability for a cream to affect gene expression, which we’ve never had that before. To be able to give somebody a drug holiday is remarkable and so novel.

Transcript edited for clarity.

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