Aaron Sookhoo, PA-C: Roflumilast Cream Moves to the Psoriasis Care Forefront

Aaron Sookhoo, PA-C

Credit: LinkedIn

It has been nearly 1 year since the US Food and Drug Administration (FDA) approved roflumilast cream (ZORYVE) 0.3% for the treatment of plaque psoriasis in patients ≥12 years old.¹

The Arcutis Biotherapeutics PDE4 inhibitor provided a non-steroidal daily topical therapy option to the armamentarium of dermatologists, on the basis of phase 3 data showing a significantly improved likelihood of clear or almost clear skin at 8 weeks of treatment.²

In an interview with HCPLive during the Fall Clinical Dermatology 2023 Conference for PAs & NPs in Orlando, FL, this weekend, Aaron Sookhoo, PA-C, of Suncoast Skin Solutions, discussed the immediate real-world impact of roflumilast cream on his psoriasis patients, as well his thoughts on continued research and indicated use for the topical therapy.

HCPLive: Can you reflect on the first year of availability of roflumilast cream for psoriasis? What has been the prescriber and patient reception thus far to it?

Sookhoo: I feel like it's gained a lot of traction. It's a great medication. We need medications in the topical space that are not steroids. It is, in fact, not a steroid, so there's a lot of benefits to it. Prescribing-wise, it's really moved to the forefront. We're using more and more prescriptions for it. I think overall, patients have really come to understand that there's more medications coming through the pipeline, and it seem like there's a renewed excitement about it.

HCPLive: Regarding the status of new or real-world data for the agent, specifically speaking to longer-term efficacy and safety, are we learning anything more since the pivotal phase 3 findings?

Sookhoo: I think the real-world data is very similar to what was found in the studies of the pivotal trials. I'm having patients who use it with complete clearance and they're not having any breakthrough at the moment. I've had it out-competing that of the topical steroids that we prescribe on a routine basis. So overall, I actually think that it's living up to the hype.

HCPLive: With consideration to where it fits in the armamentarium for psoriasis treatment right now: where exactly do you see roflumilast cream fitting relative to these other available agents?

Sookhoo: I think eventually it's going to be a step ahead. I do think it's going to become part of routine practice. I think it can become more of a staple as time goes on. I think a lot insurance companies—just in my personal experience or personal opinion—may start using it as a first-line medicine before you can get a biologic, because it is that good of a medication.

HCPLive: In the pivotal DERMIS data, there was allusion to the need to learn a bit more about its interaction with other active treatments already available for patients with psoriasis. Based off of the understanding of the PDE4 inhbitor drug class, what other active treatments may be most pivotal for us to understand that interaction with, and what real-world interactions have we seen thus far?

Sookhoo: I think we can use more information on how it plays well with biologics as a whole, not just other topical medications—other systemic medications, including oral and injectable. I think that's going to be a continuing ongoing field of study there. I've ran my own personal clinical trials in my practice, where I'm just monitoring patients that I have on systemic medications and using (roflumilast cream). And I've had great outcomes thus far, but we'll need something that's going to be finite and maybe backed by more clinical trials.

HCPLive: Regarding comorbidity benefit: obviously, psoriasis has a lot of interplay with psoriatic disease and otherwise inflammatory disease risk. Have we seen any benefit for patients who may be presenting with comorbid psoriatic arthritis or otherwise?

Sookhoo: Not entirely. Because the systemic absorption is very low, we're probably not going to see differences with psoriatic arthritis or things that would probably require systemic therapy. I haven't noticed that yet.

HCPLive: What more do you want to learn about the agent itself, as it currently stands in June 2023?

Sookhoo: I would like to learn more about other disease states that we can use it in. I've been (interested in) using it off-label for a couple of other medication diagnoses and things of that nature, so I think that there's going be a lot more utility of that medication going forward.

References

1. ^{Kunzmann K. FDA Approves Roflumilast Cream for Adolescents with Plaque Psoriasis. HCPLive. Published July 29, 2022. https://www.hcplive.com/view/fda-approves-roflumilast-cream-for-adolescents-with-plaque-psoriasis}
2. ^{Kunzmann K. Roflumilast Cream Significantly Benefits Psoriasis Severity, Itch in Phase 3 DERMIS Trials. Published March 25, 2022. https://www.hcplive.com/view/roflumilast-cream-psoriasis-severity-itch-phase-3-dermis-trials}