Can you please describe where topicals fit in when you treat psoriasis including an estimate of the percentage of the psoriasis patients in your practice who are on a topical.  

What percentage of patients on biologics or oral therapies are also using a topical?

Topical steroids can cause stretch marks, thinning, spider veins, and reactions with withdrawal. Broadly, what is your view on topical steroids in psoriasis and how enthusiastic are you about the availability of new topical non steroidal options?

How do you view roflumilast and tapinarof in terms of efficacy? Do you see them as differentiated from each other in terms of efficacy?

For roflumilast, it appears to be very effective on knees and elbows? Do you view this an important product feature ?

The data set for tapinarof’s phase 3’s had an efficacy endpoint at 12 weeks vs roflumilast being an 8 week endpoint. It also appears at the 8 week mark, roflumilast topical is more effective than Otezla. Do you view a quicker onset as being an important factor when prescribing?

Folliculits was 20.6% and 15.7% in the pivotal trials for tapinarof but the discontinuation rates due to folliculitis were 1.8% and .9%. How do you view the incidence of folliculitis in this context?

About 70 percent of roflumilast patients reported a 4 or more point reduction in itch. For tapinarof, it was about 60 %. Do you view this is a differentiator from existing therapies or a complaint patients have when treated with current treatments?

Do you believe tapinarof and/or roflumilast can displace generic steroids as first line treatments for psoriasis?

Roflumilast patients had a 3.5 and 2.8% rate of diarrhea in ph 3. Would you consider using roflumilast in patients who can’t tolerate Otezla due to the SE profile (21% nausea and 18 % diarrhea) ?

How important is the ability to write one prescription (roflumilast or tapinarof) that patients can use on all body areas w disease including intertriginous areas?

1. Tapinarof and roflumilast are creams but roflumilast also comes in a foam formulation for scalp psoriasis and seborrheic dermatitis.   What are your thoughts on the importance of the availability of a foam and how would it impact your prescribing?  

Is there a patient type you feel is better suited for tapinarof or for roflumilast or it essentially the same patient ?  

How do you view roflumilast and tapinarof when compared to combination products such as Wynzora and Duobrii?

Would you consider roflumilast and tapinarof only in new patients or can you describe scenarios where you could see switching a patient from other treatments?

Is pricing/access something that impacts your prescribing in psoriasis? How difficult is it for patients to get the meds your prescribe for psoriasis through their insurers.  If a product requires utilization steps vs a therapy with no pre-authorization, how important a factor is that in your prescribing?

Is there anything about these products or the psoriasis market that you feel we missed in our discussion or should be focusing on? Are there any other players you feel could be disruptive?