INTRODUCTION
Psoriasis is estimated to affect approximately 3% of the US population, which equates to over 7 million men and women.1 That estimate globally reaches approximately 40 million people.2 As a chronic, immune-mediated skin disease, psoriasis is associated with several metabolic and cardiovascular comorbidities,3-5 depression and anxiety,5-8 and reduced quality of life.6,9
A variety of treatments are available to manage the symptoms of moderate to severe psoriasis, including topical, phototherapy, oral, and biologic therapies. Even though biologic therapies have established efficacy in treating psoriasis,10 some patients are reluctant to use them due to safety and tolerability concerns, anxiety or fear of injection, inconvenience of administration, or loss of effectiveness over time.11 Patients may also hesitate to use biologics for fear of their reported adverse effects, such as tuberculosis, inflammatory bowel disease, serious infections, or depression.12 Thus, non-biologic systemic medications remain widely used with their increased availability and ease of administration.13
Deucravacitinib (Sotyktu; Bristol Myers Squibb) is an oral, small molecule that selectively inhibits tyrosine kinase 2, a member of the Janus kinase (JAK) family, by binding to its regulatory domain.14 Such binding prevents the activation of signaling pathways for multiple cytokines.14 Deucravacitinib is approved to treat moderate to severe plaque psoriasis in adults appropriate for systemic therapy or phototherapy.14 In 2 global, 52-week, randomized, controlled, phase 3 (POETYK) trials, significantly more patients responded to deucravacitinib than to placebo at week 16 or to apremilast at weeks 16 and 24 for the co-primary and other clinical endpoints, with safety outcomes similar between the 3 arms.15,16 The onset of deucravacitinib effect was observed for the psoriasis area severity index (PASI) as early as in the first week of therapy, and durability of effect was seen through week 52.15-17 Further, significantly better total scores for the psoriasis symptoms and signs diary (PSSD) and dermatology life quality index (DLQI), as well as the proportion of patients with meaningful improvements in both, were found with deucravacitinib versus placebo at week 16 and apremilast at weeks 16 and 24.18 Similarly, scores for individual symptoms and signs on the PSSD improved with deucravacitinib versus placebo or apremilast, with the greatest improvements shown for itch.18 Despite the high response rate with deucravacitinib, some patients may not adequately respond and may require an add-on therapy to reach treatment goals. In particular, the addition of topical therapy has been shown to improve the efficacy of systemic agents in treating psoriasis without causing additional adverse effects.19
A variety of treatments are available to manage the symptoms of moderate to severe psoriasis, including topical, phototherapy, oral, and biologic therapies. Even though biologic therapies have established efficacy in treating psoriasis,10 some patients are reluctant to use them due to safety and tolerability concerns, anxiety or fear of injection, inconvenience of administration, or loss of effectiveness over time.11 Patients may also hesitate to use biologics for fear of their reported adverse effects, such as tuberculosis, inflammatory bowel disease, serious infections, or depression.12 Thus, non-biologic systemic medications remain widely used with their increased availability and ease of administration.13
Deucravacitinib (Sotyktu; Bristol Myers Squibb) is an oral, small molecule that selectively inhibits tyrosine kinase 2, a member of the Janus kinase (JAK) family, by binding to its regulatory domain.14 Such binding prevents the activation of signaling pathways for multiple cytokines.14 Deucravacitinib is approved to treat moderate to severe plaque psoriasis in adults appropriate for systemic therapy or phototherapy.14 In 2 global, 52-week, randomized, controlled, phase 3 (POETYK) trials, significantly more patients responded to deucravacitinib than to placebo at week 16 or to apremilast at weeks 16 and 24 for the co-primary and other clinical endpoints, with safety outcomes similar between the 3 arms.15,16 The onset of deucravacitinib effect was observed for the psoriasis area severity index (PASI) as early as in the first week of therapy, and durability of effect was seen through week 52.15-17 Further, significantly better total scores for the psoriasis symptoms and signs diary (PSSD) and dermatology life quality index (DLQI), as well as the proportion of patients with meaningful improvements in both, were found with deucravacitinib versus placebo at week 16 and apremilast at weeks 16 and 24.18 Similarly, scores for individual symptoms and signs on the PSSD improved with deucravacitinib versus placebo or apremilast, with the greatest improvements shown for itch.18 Despite the high response rate with deucravacitinib, some patients may not adequately respond and may require an add-on therapy to reach treatment goals. In particular, the addition of topical therapy has been shown to improve the efficacy of systemic agents in treating psoriasis without causing additional adverse effects.19
