Comparative Efficacy of Deucravacitinib and Adalimumab for Scalp Psoriasis: An Indirect Treatment Comparison

August 2025 | Volume 24 | Issue 8 | 788 | Copyright © August 2025


Published online July 31, 2025

Vardhaman Patel PhD MSa, Alexa Hetzel MS PA-Cb, Sang Hee Park MPHa, Malcolm Hogan MSca, Ying Wu PhDa, Mirko Fillbrunn PhDc, Oscar Patterson-Lomba PhDc, Elyse Swallow MPPc, Jerry Bagel MDB

aBristol Myers Squibb, Princeton, NJ
bPsoriasis Treatment Center of New Jersey, East Windsor, NJ
cAnalysis Group, Inc, Boston, MA

Abstract

Background: Plaque psoriasis of the scalp, a common psoriasis location, remains difficult to manage. The comparative efficacy of newer oral agents, such as deucravacitinib, versus traditional first-generation biologics has not been characterized in the treatment of scalp psoriasis. This study indirectly compared the long-term efficacy of deucravacitinib versus that of adalimumab for the treatment of scalp psoriasis.
Methods: A literature review identified trial publications reporting long-term efficacy (≥48 weeks) of adalimumab in patients with scalp psoriasis. Based on a feasibility assessment, summary-level adalimumab data (VOYAGE 1 trial [NCT02207231]) were deemed suitable for comparison to patient-level deucravacitinib data (POETYK PSO-1 trial [NCT03624127]). Unadjusted analyses and adjusted analyses using an unanchored matching-adjusted indirect comparison (MAIC) approach were used to describe and compare baseline characteristics and efficacy outcomes in terms of rates of achievement of clear or almost clear scalp psoriasis (scalp-specific Physician Global Assessment score of 0/1 [ss-PGA 0/1]) at weeks 16, 24, and 48.
Results: Cross-trial differences were observed in age, race, severe scalp psoriasis, and quality of life scores. A larger percentage of patients achieved ss-PGA 0/1 at week 48 with deucravacitinib (unadjusted: 76.7%; adjusted: 73.0%) versus adalimumab (60.5%). Similarly, a larger percentage of patients achieved ss-PGA 0/1 at weeks 16 and 24 with deucravacitinib versus adalimumab.
Conclusions: In this study, treatment with deucravacitinib was effective in treating scalp psoriasis and, when compared with adalimumab, was also associated with a larger percentage of patients achieving ss-PGA 0/1 over 48 weeks.

INTRODUCTION

Plaque psoriasis is an immune-mediated inflammatory disease characterized by red, itchy, raised lesions and flaking that affects more than 100 million people worldwide.1-5 Psoriasis can affect any part of the body, yet a recent survey indicated that approximately 53.5% of patients experience psoriasis on the scalp.6 Symptoms of scalp psoriasis include small patches of itchy, dry skin that flakes off, or may be more severe, resulting in thick, lumpy, silver or white scales or inflamed, crusted patches across the entire scalp that may extend to the forehead, back of the neck, and ears.2,4,7,8 Regardless of symptom severity, patients often experience social, physical, or mental and emotional difficulties that may negatively affect their quality of life.2,6-9

Multiple treatment options for scalp psoriasis are available, yet the condition remains difficult to treat because of challenges stemming from disease severity, treatment response, and patients’ treatment preferences.4,7-9 Although primarily managed with topical therapies, the use of newly developed biologic and systemic agents may be a more convenient alternative for the treatment of psoriasis.4,6,8,9 The efficacy of oral agents, such as deucravacitinib, has not been characterized in comparison to traditional first-generation biologics in the treatment of scalp psoriasis. More specifically, deucravacitinib10 and adalimumab11 are both approved in the United States for the treatment of plaque psoriasis, yet no head-to-head comparisons between these 2 agents have been conducted. Unanchored matching-adjusted indirect comparisons (MAICs) have been shown to provide valid relative treatment effect estimates when direct treatment comparisons are lacking.12 In the absence of head-to-head clinical trials, the current study was designed to indirectly compare the effectiveness of deucravacitinib and adalimumab for the treatment of patients with scalp psoriasis.

MATERIALS AND METHODS

Data Sources
A targeted literature search was conducted on June 28, 2023, to identify clinical studies of adalimumab. Studies of interest were those with a patient population comparable to that of the
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