Short-, Mid-, and Long-Term Efficacy of Deucravacitinib Versus Biologics and Nonbiologics for Plaque Psoriasis: A Network Meta-Analysis

April W Armstrong; Richard B Warren; Yichen Zhong; Joe Zhuo; Allie Cichewicz; Ananth Kadambi; Daniela Junqueira; Tracy Westley; Renata Kisa; Carolin Daamen; Matthias Augustin

doi:10.1007/s13555-023-01034-7

Short-, Mid-, and Long-Term Efficacy of Deucravacitinib Versus Biologics and Nonbiologics for Plaque Psoriasis: A Network Meta-Analysis

Dermatol Ther (Heidelb). 2023 Nov;13(11):2839-2857. doi: 10.1007/s13555-023-01034-7. Epub 2023 Oct 6.

Authors

April W Armstrong^{1

2}, Richard B Warren^{3

4}, Yichen Zhong⁵, Joe Zhuo⁵, Allie Cichewicz⁶, Ananth Kadambi⁶, Daniela Junqueira⁶, Tracy Westley^{6

7}, Renata Kisa⁵, Carolin Daamen⁵, Matthias Augustin⁸

Affiliations

¹ University of California Los Angeles, Los Angeles, CA, USA. aprilarmstrong@post.harvard.edu.
² Division of Dermatology, David Geffen Department of Medicine, University of California Los Angeles, 2001 Santa Monica Boulevard, Suite 1090, Santa Monica, CA, 90404, USA. aprilarmstrong@post.harvard.edu.
³ Dermatology Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK.
⁴ NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
⁵ Bristol Myers Squibb, Princeton, NJ, USA.
⁶ Evidera, a part of Thermo Fisher Scientific, Waltham, MA, USA.
⁷ Lumanity, Sheffield, UK.
⁸ Institute for Health Services Research in Dermatology and Nursing, University Medical Center, Hamburg, Germany.

Abstract

Introduction: Deucravacitinib, a newly approved oral medication for the treatment of patients with moderate to severe plaque psoriasis, demonstrated efficacy versus apremilast and placebo in two phase 3 randomized controlled trials (RCTs). A systematic review and network meta-analysis (NMA) indirectly compared deucravacitinib with other relevant systemic biologic/nonbiologic treatments.

Methods: Online databases were searched for RCTs published through October 2021. Eligible studies were head-to-head comparisons between systemic therapies and/or placebo reporting 50%, 75%, 90%, or 100% improvement in Psoriasis Area and Severity Index (PASI) from baseline in adults with moderate to severe plaque psoriasis. Comparisons included tumor necrosis factor inhibitors, interleukin (IL)-17, IL-23, and IL 12/23 inhibitors, and systemic nonbiologics. A multinomial Bayesian NMA was used to derive estimates of the relative efficacy of deucravacitinib and other systemic therapies. Response probabilities for each treatment and corresponding 95% credible intervals (CrIs) for achieving a PASI response were calculated over short-, mid-, and long-term follow-up (weeks 10-16, 24-28, and 44-60).

Results: The NMA included 47 RCTs. Deucravacitinib showed the highest PASI 75 response rates among nonbiologic systemic therapies across time points. Deucravacitinib PASI 75 response rate (95% CrI) over short-term follow-up was 54.1% (46.5-61.6), within the range of first-generation biologics (etanercept, 39.7% [31.6-48.3]; infliximab, 79.0% [74.0-83.5]). At mid-term follow-up, deucravacitinib PASI 75 increased to 63.3% (58.0-68.4). At long-term follow-up, deucravacitinib PASI 75 was 65.9% (58.0-73.4), comparable to first-generation biologics adalimumab (62.8%; 55.3-69.6) and ustekinumab (68.0%; 64.6-71.5).

Conclusions: Patients receiving deucravacitinib were more likely to achieve PASI 75 response versus apremilast and methotrexate across all time points. The long-term PASI 75 response rate for deucravacitinib was similar to those of adalimumab and ustekinumab. The approval of deucravacitinib offers patients the choice of an oral therapy with long-term efficacy similar to that of some biologics.

Keywords: Biologics; Deucravacitinib; Indirect treatment comparison; Network meta-analysis; Non-biologics; Psoriasis.