What is the recommended dosage and treatment regimen for Tapinarof (aryl hydrocarbon receptor modulator) cream in adults with plaque psoriasis?

Tapinarof Dosage and Treatment Regimen for Adults with Plaque Psoriasis

For adults with plaque psoriasis, tapinarof cream 1% should be applied as a thin layer to affected areas once daily. 1

Medication Information

Tapinarof (VTAMA®) is an aryl hydrocarbon receptor (AHR) agonist that has been FDA-approved for the topical treatment of plaque psoriasis in adults. It represents a novel non-steroidal topical option with several advantages over traditional topical therapies.

Mechanism of Action

• Tapinarof modulates the aryl hydrocarbon receptor, which:
  • Reduces IL-17A production by CD4+ T cells
  • Increases barrier gene expression in keratinocytes (filaggrin and loricrin)
  • Reduces production of reactive oxygen species 2

Dosing Protocol

Application Instructions

• Apply a thin layer of tapinarof cream 1% to affected areas once daily 1
• For external use only - not for oral, ophthalmic, or intravaginal use 1
• Continue daily application until clearance is achieved

Treatment Duration

• In clinical trials, the initial treatment period was 12 weeks 3
• Long-term maintenance therapy is possible with continued once-daily application 4

Clinical Efficacy

Tapinarof has demonstrated significant efficacy in multiple Phase 3 clinical trials:

• PSOARING 1 & 2 trials (12-week treatment period):

  • 35.4% to 40.2% of patients achieved PGA score of 0 (clear) or 1 (almost clear) with ≥2-point improvement from baseline 3
  • Significantly superior to vehicle control (p<0.001) 3

• PSOARING 3 trial (long-term extension study):

  • 40.9% of patients achieved complete disease clearance (PGA=0) 4
  • 58.2% of patients entering with PGA≥2 achieved PGA=0 or 1 4
  • Remittive effect: After achieving complete clearance, patients experienced approximately 4 months (mean 130.1 days) of remission off therapy 4

Safety Profile

Common Adverse Events (≥1% incidence)

• Folliculitis (most common, 22.7% in long-term study)
• Nasopharyngitis
• Contact dermatitis (5.5% in long-term study)
• Headache
• Pruritus
• Influenza
• Upper respiratory tract infection (4.7% in long-term study) 1, 4

Important Safety Considerations

• Adverse events are generally mild to moderate in severity
• Most adverse reactions are localized to the application site
• Low discontinuation rates due to adverse events 5
• Limited systemic absorption even under maximal use conditions 6
• No contraindications listed in FDA labeling 1

Practical Application Tips

• Tapinarof can be used on various body areas affected by plaque psoriasis
• Efficacy has been demonstrated across different body regions, including difficult-to-treat areas 5
• The non-steroidal nature of tapinarof makes it suitable for longer-term use without the concerns associated with topical corticosteroids (skin atrophy, tachyphylaxis) 2
• Tapinarof represents a valuable addition to the psoriasis treatment armamentarium, particularly for patients who:
  • Have concerns about topical steroid use
  • Require long-term topical therapy
  • Have inadequate response to other topical treatments

Monitoring Recommendations

• Evaluate treatment response after 12 weeks of continuous therapy
• If complete clearance (PGA=0) is achieved, consider a treatment holiday to benefit from the remittive effect
• Resume treatment if psoriasis recurs (PGA≥2)

Tapinarof cream 1% offers a novel, effective, and well-tolerated non-steroidal option for adults with plaque psoriasis, with the added benefit of a remittive effect after treatment discontinuation.