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

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

April W Armstrong  1   2 , Richard B Warren  3   4 , Yichen Zhong  5 , Joe Zhuo  5 , Allie Cichewicz  6 , Ananth Kadambi  6 , Daniela Junqueira  6 , Tracy Westley  6   7 , Renata Kisa  5 , Carolin Daamen  5 , Matthias Augustin  8
Affiliations

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

April W Armstrong et al. Dermatol Ther (Heidelb). 2023 Nov.

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.

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Conflict of interest statement

April W. Armstrong has received grants and personal fees from AbbVie, Bristol Myers Squibb, Eli Lilly, Janssen, Leo Pharma, and Novartis; personal fees from Boehringer Ingelheim/Parexel, Celgene, Dermavant, Genentech, GlaxoSmithKline, Menlo Therapeutics, Merck, Modernizing Medicine, Ortho Dermatologics, Pfizer, Regeneron, Sanofi Genzyme, Science 37, Sun Pharma, and Valeant, and grants from Dermira, Kyowa Hakko Kirin, and UCB. Richard Warren has received research grants from AbbVie, Almirall, Amgen, Celgene, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, and UCB; and consulting fees from AbbVie, Almirall, Amgen, Biogen, Boehringer Ingelheim, Celgene, DiCE, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Sanofi, UCB, and Union. Yichen Zhong, Joe Zhuo, Renata Kisa, and Carolin Daamen are employees of and shareholders in Bristol Myers Squibb. Allie Cichewicz, Ananth Kadambi, Daniela Junqueira, and Tracy Westley are employed by Evidera, a part of Thermo Fisher Scientific, a company that provides consulting and other research services to Bristol Myers Squibb. Matthias Augustin has served on advisory boards for AbbVie, Amgen, Boehringer Ingelheim, Janssen Biotech, and Leo Pharma; has received consulting fees from AbbVie, Amgen, Eli Lilly, Janssen Biotech, Leo Pharma, Novartis, Sun Pharma, and UCB; has received honoraria from AbbVie, Amgen, Boehringer Ingelheim, Eli Lilly, Janssen Biotech, Leo Pharma, Novartis, Sun Pharma, and UCB; has served as an investigator for AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen Biotech, Leo Pharma, Merck, Novartis, Sun Pharma, and UCB; has received research grants from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Janssen Biotech, Leo Pharma, Merck, and Sun Pharma; and has served as a speaker for AbbVie, Amgen, Janssen Biotech, Leo Pharma, Sun Pharma, and UCB.

Figures

Fig. 1
Fig. 1
Network plot of studies included in the short-term (10–16 weeks) analysis (a), and short-term estimated PASI 75 response,a posterior median, and 95% CrI (b). aAdjusted for placebo response rates. bBIM is not approved for use in the USA. Note: Posterior median value given for each therapy; error bars represent 95% CrI. ADM adalimumab, APR apremilast, BIM bimekizumab, BIW twice weekly, BRO brodalumab, CrI credible interval, DEUC deucravacitinib, ETC etanercept, GUS guselkumab, IFX infliximab, IL interleukin, IXE ixekizumab, MTX methotrexate, NMA network meta-analysis, PASI Psoriasis Area and Severity Index, PBO placebo, QW once every week, Q2W once every 2 weeks, RIS risankizumab, SEC secukinumab, TIL tildrakizumab, TNF tumor necrosis factor, UST ustekinumab
Fig. 2
Fig. 2
Network plot of studies included in the mid-term (24–28 weeks) analysis (a), and mid-term estimated PASI 75 response,a posterior median, and 95% CrI (b). aAdjusted for placebo response rates. bBIM currently is not approved for use in the USA. Note: Posterior median value given for each therapy; error bars represent 95% CrI. ACT acitretin, ADM adalimumab, APR apremilast, BIM bimekizumab, BIW twice weekly, BRO brodalumab, CrI credible interval, DEUC deucravacitinib, ETC etanercept, GUS guselkumab, IFX infliximab, IL interleukin, IXE ixekizumab, MTX methotrexate, NMA network meta-analysis, PASI Psoriasis Area and Severity Index, PBO placebo, QW once every week, Q2W once every 2 weeks, Q4W once every 4 weeks, Q8W once every 8 weeks, RIS risankizumab, SEC secukinumab, TIL tildrakizumab, TNF tumor necrosis factor, UST ustekinumab
Fig. 3
Fig. 3
Network plot of studies included in the long-term (44–60 weeks) analysis (a), and long-term estimated PASI 75 response,a posterior median, and 95% CrI (b). aAdjusted for placebo response rates.bBIM is not approved for use in the USA. Note: posterior median value given for each therapy; error bars represent 95% CrI. ADM adalimumab, APR apremilast, BIM bimekizumab, BIW twice weekly, BRO brodalumab, CrI credible interval, DEUC deucravacitinib, ETC etanercept, GUS guselkumab, IFX infliximab, IL interleukin, IXE ixekizumab, MTX methotrexate, NMA network meta-analysis, PASI Psoriasis Area and Severity Index, PBO placebo, Q2W every 2 weeks, Q4W once every 4 weeks, Q8W once every 8 weeks, RIS risankizumab, SEC secukinumab, TIL tildrakizumab, TNF tumor necrosis factor, UST ustekinumab
Fig. 4
Fig. 4
Estimated odds ratios from the network meta-analysis for (a) short-term (10–16 weeks) PASI 75, (b) mid-term (24–28 weeks) PASI 75, and (c) long-term (44–60 weeks) PASI 75. ADM adalimumab, APR apremilast, BIM bimekizumab, BIW twice weekly, BRO brodalumab, CrI credible interval, DEUC deucravacitinib, ETC etanercept, GUS guselkumab, IFX infliximab, IL interleukin, IXE ixekizumab, MTX methotrexate, NMA network meta-analysis, PASI Psoriasis Area and Severity Index, PBO placebo, Q2W every 2 weeks, Q4W once every 4 weeks, Q8W once every 8 weeks, RIS risankizumab, SEC secukinumab, TIL tildrakizumab, TNF tumor necrosis factor, UST ustekinumab
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