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. 2025 Jun 15;17(6):e86044.
doi: 10.7759/cureus.86044. eCollection 2025 Jun.

Identifying Predictive Factors for Complete Skin Clearance at Week 52 by Deucravacitinib in Moderate-to-Severe Psoriasis: A Prospective Observational Study

Yohei Takahashi  1 , Teppei Hagino  1 , Hidehisa Saeki  2 , Eita Fujimoto  3 , Naoko Kanda  1
Affiliations

Identifying Predictive Factors for Complete Skin Clearance at Week 52 by Deucravacitinib in Moderate-to-Severe Psoriasis: A Prospective Observational Study

Yohei Takahashi et al. Cureus. .

Abstract

Background: Deucravacitinib, an oral selective tyrosine kinase 2 inhibitor, is effective for moderate-to-severe psoriasis. However, not all patients can achieve complete skin clearance (CSC) by deucravacitinib even after long-term treatment (one year). Therefore, we sought to determine predictive baseline factors of achieving CSC (Psoriasis Area and Severity Index score 0) at week 52.

Methods: In this prospective single‑center study (December 2022 - February 2025), we enrolled 77 patients aged ≥ 15 years and treated them with deucravacitinib 6 mg once daily. Baseline demographic, clinical, and laboratory factors were compared between patients who achieved CSC at week 52 and those who did not.

Results: Seventy-seven patients aged ≥ 15 years with moderate to severe psoriasis received deucravacitinib 6 mg once daily, and 15 patients achieved CSC at week 52. We compared patients' background factors and baseline clinical and laboratory indices between week 52 CSC achievers and non-achievers. The age (years) of week 52 CSC achievers (median: 55.0; IQR: 45.0-65.5) was significantly younger compared to non-achievers (median: 67.0; IQR: 55.3-76.0) (p = 0.0461, by Mann-Whitney U test; area under the curve (AUC) = 0.667). Additionally, the body mass index (BMI) of week 52 CSC achievers (median: 20.9; IQR: 18.3-22.9) was significantly lower compared to non-achievers (median: 23.6; IQR: 22.0-27.1) (p = 0.00571, by Mann-Whitney U test; AUC = 0.733). Compared to non-achievers, week 52 CSC achievers showed higher and faster improvements of nail, scalp, and genital lesions and quality of life, evaluated by the Dermatology Life Quality Index.

Conclusions: A BMI < 22.9 kg/m² and age < 61 years independently identify patients most likely to obtain CSC at week 52 with deucravacitinib. These cut‑offs can support early treatment selection and stratification in future prospective trials, facilitating personalized care for psoriasis.

Keywords: complete skin clearance; deucravacitinib; predictive factor; psoriasis; tyrosine kinase 2.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Nippon Medical School Chiba Hokusoh Hospital issued approval H-2023-095. The study was conducted in accordance with the Declaration of Helsinki (2004) and approved by the Ethics Committee of Nippon Medical School Chiba Hokusoh Hospital (protocol code H-2023-095) on December 7, 2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: Teppei Hagino, Hidehisa Saeki, and Naoko Kanda received lecture fees from Bristol Myers Squibb. The other authors have no conflicts of interest to be disclosed. Hidehisa Saeki is an Editorial Board member of the Journal of Dermatology and a co-author of this article. To minimize bias, he should be excluded from all editorial decision-making related to the acceptance of this article for publication.

Figures

Figure 1
Figure 1. The receiver operating characteristic curves for evaluating the predictive abilities of age and body mass index (BMI) for complete skin clearance at week 52 of deucravacitinib treatment. The area under the curve (AUC) for age is 0.667 (95% CI: 0.516–0.819), and that for BMI is 0.733 (95% CI: 0.596–0.870).
Figure 2
Figure 2. The transitions of total Psoriasis Area and Severity Index (PASI), PASI on individual anatomical sites (head and neck, trunk, upper limbs, lower limbs), and Dermatology Life Quality Index (DLQI) in long-term complete skin clearance (CSC) achievers (n = 15, blue) and non-achievers (n = 62, orange) during the treatment with deucravacitinib 6 mg. Data are mean values at weeks 0, 4, 16, 24, 36, and 52.
Figure 3
Figure 3. The achievement rates of scalp-specific physician’s global assessment (ss-PGA) 0, PGA of fingernail psoriasis (PGA-F) 0, and genital PGA 0 during the treatment with deucravacitinib 6 mg. Data are percentages for long-term CSC achievers (blue) and non-achievers (orange) at weeks 0, 4, 16, 24, 36, and 52. The number of long-term CSC achievers and non-achievers was 13 and 57 in scalp analysis, seven and 38 in fingernail analysis, and nine and 38 in genital analysis, respectively.
CSC, complete skin clearance; PGA, physician’s global assessment.
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