Real-world Perspectives on the Role of TYK2 Inhibitors in the Treatment of Psoriasis
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Real-world Perspectives on the Role of TYK2 Inhibitors in the Treatment of Psoriasis • Interim Outcomes Report (6 month) • Enduring Availability: September 30, 2021 – September 30, 2022 • https://www.mycme.com/courses/real-world-perspectives-on-the-role-of-tyk2-inhibitors-in- the-treatment-of-psoriasis-7860 • Pending release on Epocrates, estimated April 1, 2022 – September 30, 2022 • Sponsored by the Academy for Continued Healthcare Learning (ACHL) • Primary Contact: Amanda Kaczerski, MS, CHCP (akaczerski@achlcme.org) • Data as of: February 25, 2022 • Date Submitted: March 8, 2022 • Moore's Outcomes Levels: 1-4 Level Planned Level Reached Level 4 Level 4 Medical Education BMS Grant ID 67832115 Confidential 1
Real-world Perspectives on the Role of TYK2 Inhibitors in the Treatment Faculty of Psoriasis (BMS Grant ID # 67832115) • April Armstrong, MD, MPH • Neal Bhatia, MD • Provided by the Academy • Total Cost of Activity: LEARNER PARTICIPATION • Mark Lebwohl, MD for Continued Healthcare $97,375 Total Actual Unique Learners Learning (ACHL) BMS Support: $97,375 • September 30, 2021 – Meeting Agenda BMS Cost per Learner: TOTAL MDs/DO NP/PA PharmD Other September 30, 2022 $81.15 (est. 1200 Learners • CME Link: participants) • TYK2 Inhibition: A Rational and Effective Approach to https://www.mycme.com/cou 259 28% (73) 57% (148) 1% (3) 14% (35) Psoriasis rses/real-world-perspectives- • Target Audience • Immunological pathways involved in the on-the-role-of-tyk2-inhibitors- • Other HCPs include nurses, case managers, dietitian pathogenesis of psoriasis in-the-treatment-of-psoriasis- dermatologists, 7860 dermatology NPs & PAs, and unknown (guest users) • The JAK/STAT pathway as a rational approach Direct to Activity: primary care providers, Breakdown of Physician Learners • Unmet clinical needs and novel targets https://www.achlcme.org/dig and other healthcare TOTAL • Latest TYK2 inhibitor clinical evidence –make ital/PSO210/index.html providers who treat Dermatolog GP/Internal primary focus of this section Physician Other • Ongoing trials with TYK2 inhibitors in psoriasis patients with psoriasis. ists Medicine Learners • Distinguishing TYK2 inhibitors from more Credit Offered 72 29% (21) 32% (23) 39% (28) conventional JAK inhibitors • 1.00 AMA PRA Category 1 Credit • Real World Perspectives on Incorporating Novel and • Other HCPs include cardiologists, hospitalists, Emerging Therapeutics into an Optimal Treatment orthopedics, immunologists, surgeons Approach Learning Objectives US vs Ex-US Learners • Current treatment paradigms • Evaluate emerging TYK2 inhibitors based on their US Ex-US • Patient selection criteria mechanistic profiles, safety, efficacy and routes of • Moving toward personalized management administration 98% (254) 2% (5) strategies • Assess clinical implications of emerging evidence for in • Application of latest clinical evidence to treatment paradigm meeting unmet clinical needs for refractory psoriasis patients • Limitations of guidelines Post Activity Gains Up to 970 • Defining targets and timelines • Model current and future treatment strategies for refractory 30% (n=216) patients • Mitigating risks patients considerate of disease activity, treatment response, Average increase in impacted • Shared decision-making approaches and other patient-specific factors knowledge and weekly competence 2
Faculty April Armstrong, MD, MPH Professor of Dermatology Associate Dean for Clinical Research Director of Clinical Research Support, Southern California Clinical and Translational Science Institute Vice Chair | Director, Clinical Trials and Outcomes Research | Director, Psoriasis Program Keck School of Medicine at USC University of Southern California Los Angeles, CA Neal Bhatia, MD Director of Clinical Dermatology Therapeutics Clinical Research San Diego, CA Mark Lebwohl, MD Dean for Clinical Therapeutics Chairman Emeritus Kimberly and Eric J. Waldman Department of Dermatology Icahn School of Medicine at Mount Sinai New York, NY Medical Education BMS Grant ID 67832115 Confidential 3
Learner Demographics Anticipated “Attendance” per portal submission vs actual participants (an HCP who viewed the CME/CE front matter) Anticipated Actual Learners (n=259) Participants Participants MD Dematologist N=3, 1% N=16, N=1,650 N=913 MD GP / Internal N=21, 8% N=21, 8% Medicine Anticipated Learners as per N=23, 9% MD Other proposal vs Actual Learners NP Anticipated Learners Actual Learners N=28, 11% (OSP) (OSP) PA N=750 N=259 N=23, 9% Nurse Practice Setting N=124, 48% Pharmacist HCPs in HCPs in Other (Dietitan, Case HCPs in Private Manager) Academic Community Other Setting Practice Setting Setting 12% 12% 53% 23% (N=32) (N=30) (N=136) (N=61) Medical Education BMS Grant ID 67832115 Confidential 7
Gains in knowledge, competence, and confidence (include absolute % for each gain based on pre/post-test responses and indicate the supporting slide referencing the respective gain) • Increased familiarity with emerging TYK2 inhibitors (LO1, 16%, slide Gain #1 7) Gain #2 • Significantly improved knowledge of the route of administration for deucravacitinib (LO2, 41%, slide 13) Gain #3 • Improved competence with selecting therapy for refractory moderate-to-severe psoriasis (LO3, 3%, slide 16) Gain #4 • Significantly improved knowledge with TYK2 inhibitor pharmacology (LO1, 38%, slide 12) • Significantly increased knowledge of deucravacitinib clinical trial Gain #5 data (LO1, 36%, slide 14) Medical Education BMS Grant ID 67832115 Confidential 8
Learner Remaining Practice Gaps (include absolute % for each gap based on pre/post-test responses and indicate the supporting slide referencing the respective gap) • Despite moderate reported confidence with selecting therapy for patients with Practice Gap #1 refractory moderate-to-severe psoriasis, most learners continued to incorrectly select therapy for these patients post-activity. Education should focus on experiential learning (case-based) to foster skills while simultaneously bolstering confidence. (43% post- activity competence, slide 16; 25% for highest level of confidence, slide 8) • As the TYK2 inhibitors continue to be developed, clinicians would benefit from additional education that differentiates TYK2 inhibitors from conventional JAK Practice Gap #2 inhibitors through engaging education and strategies that support improved knowledge gains. (25% for highest level of familiarity, slide 7) • Future education should model evidence based on applying the latest safety data with the TYK2 inhibitors. Additional education with strategies such as practice aids (eg, Practice Gap #3 patient workup sheets) and roundtable discussions will provide multidisciplinary team- based avenues for translating knowledge to practice. (75% post-activity knowledge, slide 15) Medical Education BMS Grant ID 67832115 Confidential 9
Clinical ClinicalFamiliarity: Familiarity:Emerging EmergingTYK2 TYK2Inhibitors Inhibitors Moore’s Level Achieved: 3 Moore’s Level Achieved: 3 Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes of Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes administration of administration Question: How familiar are you with emerging TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? Question: How familiar are you with emerging TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? Pre, N=256 Post, N=216 9% It is key that clinicians are Very familiar 25% familiar with the promising TYK2 inhibitors in development for moderate-to-severe psoriasis. After completing this activity, the 29% percentage of learners who Somewhat familiar identified as “very familiar” with 45% emerging TYK2 inhibitors increased 16%. This increased familiarity should translate to 62% more optimized use of these Not at all familiar agents once they become 30% available. 0% 20% 40% 60% 80% 100% Medical Education Grant ID: 67832115 Confidential 7
Clinical ClinicalConfidence: Familiarity:Selecting EmergingTherapy for Refractory Moderate-to-Severe Psoriasis TYK2 Inhibitors Moore’s Level Achieved: Moore’s Level Achieved: 33 Learning Objective: Model current and future treatment strategies for refractory patients considerate of disease activity, treatment Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes response, and other patient-specific factors of administration Question: How confident are you with selecting therapy for patients with refractory moderate-to-severe psoriasis? Question: How familiar are you with emerging TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? Pre, N=259 Post, N=216 11% Very confident Clinicians should not only be 25% competent, but also confident, with determining optimal therapy for their patients with refractory moderate-to-severe psoriasis. 31% Learners who identified as “very Somewhat confident 49% confident” with this topic increased 14%. These gains should translate to more effective care of patients with refractory moderate-to-severe 58% psoriasis. Not at all confident 26% 0% 20% 40% 60% 80% 100% Medical Education Grant ID: 67832115 Confidential 8
Cohen’s d Effect Clinical Familiarity: Size Emerging TYK2 = 0.44 (first attempt posttest) Inhibitors Moore’s This EffectLevel Achieved: 3uses pre and posttest question responses from all pre and posttest takers. First attempt posttest scores were Size calculation Learning used Objective: to calculate Evaluatemean the posttest emerging TYK2 inhibitors and standard based on their mechanistic profiles, safety, efficacy and routes deviation. of administration Question: How familiar are you with emerging TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? Pretest Mean 42% Standard Deviation 0.25 Sample Size 259 Posttest Mean 54% Standard Deviation 0.29 Sample Size 216 An effect size of 0.44 indicates that participating clinicians are approximately 30% more knowledgeable of the content assessed than prior to participating in this education. Cohen (1988): .2 = small, .5 = medium, .8 = large Wolf (1986): .25 = educationally significant, .50 = clinically significant Cohen’s d effect size accounts for variances in learner populations and is more sensitive to the size of the learner population. As such, ACHL considers effect size to be a more robust measure of educational effectiveness than normalized gains. Medical Education Grant ID: 67832115 Confidential 9
Cohen’s d Effect Clinical Familiarity: Size Emerging TYK2 = 1.31 (last attempt posttest) Inhibitors Moore’s This EffectLevel Achieved: 3uses pre and posttest question responses from all pre and posttest takers. First attempt posttest scores were Size calculation Learning used Objective: to calculate Evaluatemean the posttest emerging TYK2 inhibitors and standard based on their mechanistic profiles, safety, efficacy and routes deviation. of administration Question: How familiar are you with emerging TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? Pretest Mean 42% Standard Deviation 0.25 Sample Size 259 Posttest Mean 71% Standard Deviation 0.19 Sample Size 216 An effect size of 1.31 indicates that participating clinicians are approximately 66% more knowledgeable of the content assessed than prior to participating in this education. Cohen (1988): .2 = small, .5 = medium, .8 = large Wolf (1986): .25 = educationally significant, .50 = clinically significant Cohen’s d effect size accounts for variances in learner populations and is more sensitive to the size of the learner population. As such, ACHL considers effect size to be a more robust measure of educational effectiveness than normalized gains. Medical Education Grant ID: 67832115 Confidential 10
Pretest vs. Clinical Familiarity: Posttest Emerging Moore’s Level Achieved: 3 Summary TYK2 Inhibitors 51% Normalized Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes of administration Change Topic Question: How familiarAbsolute are you%withAbsolute emerging% TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? (pre to last Change Change 100% post) (pre to 1st (pre to last post) post) 90% 87% 80% 77% 75% 74% TYK2 Inhibitor 70% 15% 38% 64% Pharmacology 60% 56% 56% 49% 50% Route of Administration 50% 45% 17% 41% 43% for Deucravacitinib 41% 40% 42% 40% 33% Deucravacitinib Clinical 30% 15% 36% Trial Data 20% Safety Data with 10% 11% 30% Deucravacitinib 0% MOA of the TYK2 Route of Efficacy of Safety of Therapy Selection Therapy Selection for Inhibitor Administration for Deucravacitinib Deucravacitinib for Moderate 2% 3% Moderate Psoriasis Deucravacitinib Psoriasis Pre (N=216) 1st Post (n=216) Last Post (N=259) Medical Education Grant ID: 67832115 Confidential 11
Knowledge Acquisition: Clinical Familiarity: TYK2 Inhibitor Emerging Pharmacology TYK2 Inhibitors Moore’s Level Achieved: Moore’s Level Achieved: 33 Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes of Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes administration of administration Question: Which of the following best describes the mechanism of action of the investigational TYK2 inhibitor? Question: How familiar are you with emerging TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? Pre, N=259 First Post, N=216 Last Post, N=216 Considering the bevy of adverse events and black box warnings with the JAK It exerts its action by binding to the TYK2 catalytic and 12% inhibitors, it is important for clinicians to 16% regulatory domains 4% understand how TYK2 inhibitors are P=
Knowledge Acquisition: Clinical Familiarity: Route ofTYK2 Emerging Administration Inhibitors for Deucravacitinib Moore’s Level Achieved: Moore’s Level Achieved: 33 Learning Objective: Assess clinical implications of emerging evidence for in meeting unmet clinical needs for refractory psoriasis Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes patients of administration Question: What is the route of administration of deucravacitinib? Question: How familiar are you with emerging TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? Pre, N=259 First Post, N=216 Last Post, N=216 It is critical for clinicians to understand the route of administration 7% Topical cream 5% for deucravacitinib considering the 3% P=
Knowledge Acquisition: Clinical Familiarity: Deucravacitinib Emerging Clinical Trial Data TYK2 Inhibitors Moore’s Level Achieved: Moore’s Level Achieved: 33 Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes of Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes administration of administration Question: Which of the following is correct regarding the efficacy with deucravacitinib? Question: How familiar are you with emerging TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? Pre, N=259 First Post, N=216 Last Post, N=216 Clinicians need to understand the latest evidence with deucravacitinib 5% to ensure it is properly incorporated Deucravacitinib did not demonstrate superior PASI 75 and PASI 3% 90 responses at Week 16 compared to placebo P=
Clinical Familiarity: Knowledge Emerging Acquisition: TYK2with Safety Data Inhibitors Deucravacitinib Moore’sLevel Moore’s Level Achieved:3 3 Achieved: Learning Objective:Evaluate LearningObjective: Evaluateemerging emergingTYK2 TYK2inhibitors inhibitorsbased basedonontheir theirmechanistic mechanisticprofiles, profiles,safety, safety,efficacy efficacyand androutes routesof administration Question: Which of the following is correct about recent safety data with deucravacitinib? of administration Question: How familiar are you with emerging TYK2 inhibitors for the treatment of moderate-to-severe psoriasis? Pre, N=259 First Post, N=216 Last Post, N=216 It is important that clinicians 16% comprehend not only the efficacy, Deucravacinib was associated with opportunistic systemic 10% but also the safety considerations infections 8% P=
Clinical Competence: Therapy Selection for Refractory Moderate-to-Severe Psoriasis ClinicalLevel Moore’s Familiarity: Achieved:Emerging 4 TYK2 Inhibitors Moore’sObjective: Learning Model 3current and future psoriasis treatment strategies for refractory patients considerate of Level Achieved: Learning disease Objective: activity, Evaluate treatment emerging response, andTYK2 inhibitors other based on factors patient-specific their mechanistic profiles, safety, efficacy and routes Question: Valerie is a 24-year-old female who has been diagnosed with moderate psoriasis (10% BSA). Of note, she also has psoriasis of administration involvement Question: Howon her palms. familiar areWhich of the you with following emerging TYK2would you prescribe inhibitors as her primary for the treatment therapy based on of moderate-to-severe best available data? psoriasis? Pre, N=259 First Post, N=216 Last Post, N=216 This question assessed learners’ 20% preference for oral therapy. Either Ustekinumab 18% ustekinumab or apremilast would 16% P=.50 work for this patient case, but the increase with the selection of apremilast showed that learners 20% are more inclined to select oral Apremilast 24% 27% therapy post-activity. A significant proportion of learners incorrectly chose therapies not indicated or 23% recommended for moderate Targeted phototherapy 15% psoriasis post-activity, highlighting 13% the need for continued education. 37% Topical steroids 43% 44% 0% 20% 40% 60% 80% 100% Medical Education Grant ID: 67832115 Confidential 16
Novel Therapy Clinical Familiarity: Incorporation Emerging TYK2 Inhibitors Moore’s Level Achieved: 3 (inter-activity) Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes of administration Question: Which How familiar of the following are would factors you with emerging make TYK2 you more inhibitors likely to for the treatment Howoflikely moderate-to-severe psoriasis? are you to incorporate deucravacitinib into incorporate a novel therapy into practice? practice once it receives FDA approval? 0% 20% 40% 60% 80% Polling, N=93 Guideline recommendations 58% 15% Additional clinical trial efficacy data 43% 45% Data demonstrating safety 53% FDA approval 58% 40% Minimal insurance barriers 48% More colleagues with experience using 23% Very likely Somewhat likely Not at all likely the agent Polling, N=113 Multiple responses allowed Over half of learners indicated that they would be more likely to incorporate a novel therapy (such as investigational deucravacitinib) into practice based on guideline recommendations, data demonstrating safety, and FDA approval. Almost all learners indicated that they also would be very or somewhat likely to incorporate deucravacitinib into practice once it is approved. Medical Education Grant ID: 67832115 Confidential 17
Novel Therapy Clinical Familiarity: Incorporation Emerging TYK2 Inhibitors Cont. Moore’s Level Achieved: 3 (inter-activity) Learning Objective: Evaluate emerging TYK2 inhibitors based on their mechanistic profiles, safety, efficacy and routes of administration Question: Which How familiar of the following are you concerns dowith youremerging TYK2with patients have inhibitors for the treatment of moderate-to-severe Please estimate the percent psoriasis? of your patients who conventional psoriasis therapy? might prefer a safe, effective oral therapy over injectable therapy for moderate-to-severe psoriasis: 0% 20% 40% 60% 80% Adverse events/safety concerns 57% Polling, N=63 2% 4% Fear of injections/needles 38% 17% 49% Limitations with efficacy 33% Insurance barriers 55% 28% Cost 50% Polling, N=64 Multiple responses allowed None 1-25% 26-50% 51-75% 76-100% Learners identified several barriers that continue to persist in refractory moderate-to-severe psoriasis care. Deucravacitinib may be able to overcome these barriers if the agent has tolerable safety, limited insurance barriers, and cost. Learners also stated that most of their patients with this condition would prefer a safe, effective oral option over injectable therapy, highlighting potential opportunities with deucravacitinib. Medical Education Grant ID: 67832115 Confidential 18
Learners’ Planned Change to Practice 12 Post, N=193 Enroll my patients with refractory psoriasis into clinical trials 22% 68% of learners will change their practice following participation in Consider comorbidities with psoriasis treatment selection 33% this activity. Among other changes, 33% will consider comorbidities Ensure comprehensive care of patients with psoriasis (e.g. 30% with psoriasis treatment selection optimal management of concomitant conditions) and 31% will consider selecting a different therapy for moderate-to- Consider selecting a different therapy for my patients with moderate-to-severe psoriasis 31% severe psoriasis. Prescribe new therapies for moderate-to-severe psoriasis as they 22% become available This activity validated my current practice; no changes will be 4% made Not applicable 28% 0% 10% 20% 30% 40% 50% 60% Multiple responses allowed Medical Education INSERT BMS BMSIDGRANT Grant ID HERE 67832115 Confidential 19
Patient Care Impact 12 Number of patients with moderate-to-severe psoriasis seen per month: Post, N=193 Changes made from this activity have the 6% potential to impact 555 to more than 970 8% 35% patients with moderate-to-severe psoriasis each month. This assumes data in the pie chart is representative of the 259 learners to-date, who 16% indicated they would change their practice as a result of participating in this activity (68%). 35% 0 1-5 6-10 11-15 >15 Medical Education INSERT BMS BMSIDGRANT Grant ID HERE 67832115 Confidential 20
Barriers to Change 12 Post, N=193 30% of learners indicated there Lack of staff time to implement change 15% were no barriers to applying the changes in their practice. Of those Do not have an implementation plan 9% HCPs who reported barriers, 72% will attempt to address the Insurance/reimbursement issues 32% perceived barrier(s) in order to affect change. Cost 27% Organizational/institutional culture 6% Patient adherence/compliance 16% Lack of supporting evidence in the literature 2% Lack of consensus or professional guidelines 4% No barriers 30% Other barriers 5% 0% 10% 20% 30% 40% 50% Multiple responses allowed Medical Education INSERT BMS BMSIDGRANT Grant ID HERE 67832115 Confidential 21
Clinically Valuable Feedback from Learners: Please list one pearl you took away as a result of participating in this activity: • A new oral medication may be coming • Consider comorbidities with psoriasis treatment selection • Differentiating TYK2 inhibitors from JAK inhibitors • Multiple uses of TYK2 • Novel agent efficacy and safety, treat scalp as special area • Oral tx available • Promising new treatment • Refer to specialist • Safe and effective • Safety reassurance • Side effects of this medication • Side effects of treatment • That the new TYK 2 inhibitor is not immunosuppressive • That TYK2 inhibitors could help patients have better control of their psoriasis • The promising nature of deucravacitinib for the treatment of mod- to severe psoriasis • There is an oral alternative on the horizon for psoriasis and psoriatic arthritis • This medication has lower incidence of cardiac events compared to Apremilast • Treatment regimen of patients with psoriatic arthritis Learners have the option to list any • TYK2 inhibitors are on the horizon for the treatment of moderate to severe plaque psoriasis remaining questions following their • TYK2 inhibitors are superior to apremilast participation in the activity, • Understanding pathophysiology of psoriasis however no questions have been • Value of tyk2 meds received to date. . Medical Education BMS Grant ID 67832115 Confidential 22
Clinically Valuable Feedback from Learners: Learner Satisfaction Please list one pearl you took away as a result of participating in this activity: 27 N=193 94% 95% 97% Overall quality of education Overall effective format Faculty were knowledgeable 72% 100% 96% Learning objectives were met Overall free from commercial bias Overall relevant content Medical Education Grant ID: 67832115 Confidential
Educational Impact Summary 1. Post-intervention, 75% of HCPs stated they are somewhat or very confident in their ability to select therapy for patients with refractory moderate-to-severe psoriasis, with a positive shift in confidence of 32 percentage points post intervention. 2. Knowledge and competency improvements were demonstrated across all learning objectives resulting in an average increase of 29 percentage points from baseline to last attempt posttest. (51% normalized gain) 3. After participating in this activity, learners identified several barriers that continue to persist in refractory moderate-to-severe psoriasis care, highlighting potential opportunities with deucravacitinib. 4. More than three-fourths of learners post-activity highlighted that the majority of their patients would prefer a safe, effective oral option over injectable therapy. 5. 68% of learners intend to change their practice as a result of this education. Of those, 30% indicated there were no barriers to applying the changes they indicated on the previous question. 6. Changes made from this activity have the potential to impact 555 to more than 970 patients with moderate-to-severe psoriasis each month. Medical Education BMS Grant ID 67832115 Confidential 24
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