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
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 of Psoriasis
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
Real-world Perspectives on the Role of TYK2 Inhibitors in the Treatment of Psoriasis
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
Real-world Perspectives on the Role of TYK2 Inhibitors in the Treatment of Psoriasis
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
Real-world Perspectives on the Role of TYK2 Inhibitors in the Treatment of Psoriasis
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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