Review Compares Psoriasis Therapies in Asian Populations

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Psoriasis management has evolved significantly with systemic treatment options, including conventional therapies, biologics, and targeted small molecules. Among biologics, first-generation tumor necrosis factor (TNF) inhibitors and interleukin (IL) 12/23 inhibitors have paved the way for IL-17 and IL-23 inhibitors. Targeted small molecules, such as apremilast, have gained popularity, and the recent addition of deucravacitinib, a selective, allosteric tyrosine kinase 2 (TYK2) inhibitor, marks a paradigm shift. Approved globally for moderate to severe plaque psoriasis, deucravacitinib has demonstrated superior efficacy compared to apremilast in the POETYK PSO-1 and PSO-2 trials.^1-2

Researchers behind a recent review stated that systematic literature reviews (SLRs) and network meta-analyses (NMAs) are instrumental in evaluating the relative efficacy of various treatments through indirect comparisons. While systemic therapies may have varying efficacies across ethnic groups due to demographic and lifestyle differences, they found NMAs targeting Asian populations are scarce. The study aimed to assess the comparative effectiveness of deucravacitinib against other systemic therapies in Asian patients with moderate to severe plaque psoriasis, focusing on patients from East Asia.³

Methods

The SLR adhered to the Cochrane Handbook for Systematic Reviews of Interventions and the National Institute for Health and Care Excellence guidelines. Electronic databases were searched for randomized controlled trials (RCTs) conducted in Asia or including Asian participants, published through January 2023. Eligible studies reported outcomes such as Psoriasis Area and Severity Index (PASI) responses (PASI 50, 75, 90, or 100). The inclusion criteria limited analysis to treatments approved in China, Japan, Korea, and Taiwan by January 2023.

Results

From 8,596 records, researchers identified20 unique RCTs to include in the NMA: 15 exclusively involved Asian populations, and 5 were Asian subgroups of global studies. The trialspredominantly enrolled Japanese, Chinese, Korean, and Taiwanese patients. Across these studies,deucravacitinib exhibited robust efficacy, surpassing placebo and apremilast in achieving PASI 75 and PASI 90 responses.

• PASI 75 Response: The review found deucravacitinib achieved a 66% response rate (95% credible interval [CrI]: 49%-80%) compared to 24% for apremilast and 1% for placebo.
• PASI 90 Response: Deucravacitinib’s response rate was reported to be 40% (95% CrI: 24%-58%), markedly higher than apremilast (9%) and placebo (1%).

In comparison to biologics, researchers reported that deucravacitinib showed similar efficacy to TNF inhibitors (adalimumab, infliximab, and certolizumab pegol), IL-12/23 inhibitors (ustekinumab), and IL-23 inhibitors (tildrakizumab). They noted deucravacitinib’s efficacy also paralleled IL-17 inhibitors such as risankizumab and secukinumab in achieving PASI 50 and PASI 100 responses.

The number needed to treat for deucravacitinib to achieve PASI 75 was 1.67, which researchers stated was significantly lower than apremilast’s 5.66, indicating a higher therapeutic efficiency. Similar trends were observed for PASI 90.

Discussion 

The review found deucravacitinib provides a novel oral treatment option for psoriasis, combining convenience with efficacy comparable to biologics. The findings underscore its potential as a preferred choice for Asian patients, given its superior efficacy over apremilast and its comparable performance to leading biologic therapies.

However, researchers stated limitations in trial size, subgroup analyses, and long-term data must be acknowledged. Most included trials were short-term, and they suggested further research is necessary to validate long-term outcomes and assess real-world effectiveness.

Conclusion

Researchers found deucravacitinib represents a significant advancement in psoriasis therapy, particularly for Asian populations. Its efficacy, safety profile, and oral administration offer a compelling alternative to biologics, broadening the treatment landscape for moderate to severe plaque psoriasis.

References

1. Armstrong AW, Warren RB, Zhong Y, et al. Short-, mid-, and long-term efficacy of deucravacitinib versus biologics and nonbiologics for plaque psoriasis: A network meta-analysis. Dermatol Ther (Heidelb). 2023;13(11):2839-2857. doi:10.1007/s13555-023-01034-7
2. Strober B, Thaçi D, Sofen H, et al. Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: Efficacy and safety results from the 52-week, randomized, double-blinded, phase 3 program for evaluation of TYK2 inhibitor psoriasis second trial. J Am Acad Dermatol. 2023;88(1):40-51. doi:10.1016/j.jaad.2022.08.061
3. Tsai T-F, Tada Y, Kung C, et al. Indirect comparison of deucravacitinib and other systemic treatments for moderate to severe plaque psoriasis in Asian populations: A systematic literature review and network meta-analysis. J Dermatol. 2024; 00: 1–13.doi:10.1111/1346-8138.17448