Management of Plaque Psoriasis in Adults: Clinical Utility of Tapinarof Cream

Riley K Spencer,1,2 Joy Q Jin,2,3 Kareem G Elhage,2 Mitchell S Davis,2 Wilson Liao,2 Tina Bhutani2 1Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA; 2Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA; 3School of Medicine, University of California at San Francisco, San Francisco, CA, USACorrespondence: Riley K Spencer, Department of Dermatology, University of California at San Francisco, Box 1212, Floor 01, Room 101, 2340 Sutter Street, San Francisco, CA, 94115, USA, Tel +1 480 415 7224, Fax +1 415 502 4126, Email rileykylespencer@gmail.comAbstract: Topical medications represent the most commonly used drugs in the treatment of psoriasis. However, topical steroids are mainly limited to short-term or intermittent use, and traditional non-steroidal topicals such as vitamin D analogues, topical calcineurin inhibitors, and topical retinoids are limited by low efficacy and poor local skin tolerability. Tapinarof (GSK2894512, DMVT-505) is a novel, topical aryl hydrocarbon receptor (AHR) agonist, which was recently approved by the FDA for the treatment of plaque psoriasis in adults. Tapinarof acts to improve psoriasis through diminished IL-17A production by CD4+ T cells, increased barrier gene expression in keratinocytes, and reduced production of reactive oxygen species. Both short-term and long-term efficacy and safety have been evaluated in two Phase II and two Phase III (PSOARING 1 and 2) clinical trials in addition to a long-term extension study (PSOARING 3). Overall, the drug has shown beneficial effects in achieving clear skin in adults with moderate-to-severe psoriasis, good local tolerability, and also a long duration of effect even after discontinuation of the drug. Therefore, this therapy provides a new, highly effective and safe non-steroidal option to add to our psoriasis treatment toolbox for both initial clearance and long-term maintenance of disease.Keywords: tapinarof, vtama, psoriasis, PSOARING