So in sculpt mode you can hold ctrl to inverse the effect of the brush, this typically has the same performance as sculpting without holding ctrl, BUT, when sculpting with a pen pressure device AND holding ctrl the mesh starts updating extremely slowly. Sculpting without holding ctrl with my xp-pen device works perfectly fine (possibly a slight performance degrade, but at least a lot better than when not holding ctrl).
Note that Im holding ctrl on my keyboard, not using the buttons on my XP Pen tablet
To demonstrate:
OS: Win10 [Version 10.0.19043.1288]
Tablet model: XP-PEN 22E Pro https://www.xp-pen.com/product/63.html
XP Pen Driver: XP-PENWin_3.2.2.211027(New UI Driver) https://www.xp-pen.com/download-67.html