Tyrosine kinase 2 inhibitor (deucravacitinib) for psoriasis: A systematic review and network meta-analysis of randomized controlled trials

Abstract

Objective: Deucravacitinib is a tyrosine kinase-2 inhibitor that shows promise as an emerging treatment option for psoriasis. We aimed to evaluate the efficacy and safety of different doses of deucravacitinib versus placebo or apremilast on psoriasis treatment. Methods: We performed a systematic review and pairwise and network meta-analyses of randomized controlled trials published in Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane Central databases from the inception of databases until 31 st March 2023. We used the risk ratio for dichotomous outcomes, and the mean difference with corresponding 95% confidence interval for continuous outcomes. We registered our protocol in PROSPERO (ID: CRD42023413976). Results: We analyzed four randomized controlled trials involving 2,156 patients randomly assigned to receive placebo, 60 mg of apremilast once daily, or various doses of deucravacitinib (3 mg every other day, 3 mg once daily, 3 mg twice daily, 6 mg twice daily, or 12 mg once daily). Deucravacitinib achieved significantly better outcomes compared with placebo across multiple efficacy measures, including the Psoriasis Area and Severity Index score (P < 0.01), Static Physician’s Global Assessment score (P < 0.01), Psoriasis Symptoms and Signs Diary score (P < 0.01), Dermatology Life Quality Index score (P < 0.01), and scalp-specific Physician’s Global Assessment score (P < 0.01). When comparing 3 mg of deucravacitinib twice daily with 60 mg of apremilast once daily, deucravacitinib exhibited superior outcomes in terms of the Psoriasis Area and Severity Index (P < 0.01), Dermatology Life Quality Index (P < 0.01), Static Physician’s Global Assessment (P < 0.01), and scalp-specific Physician’s Global Assessment scores (P < 0.01). Conclusion: Deucravacitinib and apremilast show promising efficacy as psoriasis treatments. While adverse events were more common with these treatments compared with placebo, the incidence of serious adverse events did not significantly differ between the intervention and placebo groups.