OBJECTIVES:

Deucravacitinib demonstrated superior efficacy versus apremilast and placebo in two phase 3 randomized controlled trials (RCTs) in patients with moderate to severe plaque psoriasis. A systematic review (SLR) and network meta-analysis (NMA) were performed, indirectly comparing deucravacitinib with other relevant systemic biologic/nonbiologic treatments.

METHODS:

Electronic databases were searched through October 2021 for RCTs of systemic treatments in adults with moderate to severe psoriasis, reporting Psoriasis Area and Severity Index 75% (PASI 75) response rates. NMA was performed using multinomial random effects models adjusting for baseline-placebo risk to estimate PASI 75 responses over short-, mid-, and long-term follow-ups (Weeks 10-16, 24-28, and 44-60, respectively). Phase 3 trial data were only included when nonresponder imputation was applied.

RESULTS:

The SLR identified 251 RCT publications; 45 were included in NMA. Deucravacitinib showed the best PASI 75 response rate among oral systemic therapies (methotrexate and apremilast) at Weeks 16, 24, and 52. Deucravacitinib PASI 75 response rate (95% credible interval) at Week 16 was 54.1% (46.5%-61.6%), within the range of first-generation biologics, from etanercept (39.7%; 31.6%-48.3%) to infliximab (79.0%; 74.0%-83.5%). At Week 24, PASI 75 response for deucravacitinib increased to 63.3% (58.0%-68.4%), while PASI 75 responses for first-generation biologics ranged from 43.7% (35.0%-53.0%) for etanercept to 75.0% (69.9%-79.4%) for ustekinumab. At Week 52, PASI 75 response rate for deucravacitinib was 65.9% (58.0%-73.4%), which was comparable to the most effective first-generation biologics, adalimumab (62.8%; 55.3%-69.6%) and ustekinumab (68.0%; 64.6%-71.5%). Newer interleukin-17 and -23 inhibitors showed the highest PASI 75 response rates of the included treatments across time points.

CONCLUSIONS:

Among oral treatments, deucravacitinib provided the best efficacy across time points. At 52 weeks, the PASI 75 response rate for deucravacitinib was similar to first-generation biologics. Once approved, deucravacitinib will be a potentially valuable new treatment for patients with moderate to severe psoriasis.