Deucravacitinib Versus Apremilast for Psoriasis: A Post-Hoc Analysis

April W. Armstrong, MD, MPH

Credit: X (Twitter)

Patients with moderate-to-severe plaque psoriasis may see greater cumulative benefits using deucravacitinib versus apremilast, according to new findings, as measured by 75% reductions in their Psoriasis Area and Severity Index (PASI 75) scores and achievement of a static Physician Global Assessment score of 0 or 1 (sPGA 0/1).¹

These conclusions resulted from a new post-hoc analysis of the POETYK PSO-1 study, with investigators looking at the 52-week cumulative clinical benefits of deucravacitinib compared to apremilast. They also evaluated the benefits of remaining on deucravacitinib versus remaining on apremilast versus switching.

This research was led by April W. Armstrong, MD, MPH, professor and chief of dermatology at UCLA and Chair Emeritus of the National Psoriasis Foundation’s Medical Board. Armstrong and colleagues noted that in the POETYK PSO-1 study, deucravacitinib had proven to be well tolerated, efficacious, and superior to apremilast in several different ways.²

“Therefore, we aimed to determine the overall cumulative clinical benefit of treatment initiated with deucravacitinib versus apremilast over 52 weeks in patients with moderate to severe plaque psoriasis and to compare the 52-week cumulative benefit of initiating and staying on deucravacitinib versus initiating apremilast and continuing or switching to deucravacitinib at week 24 of treatment using POETYK PSO-1 trial data,” Armstrong et al. wrote.¹

Background and Design

The investigators analysis was designed as a post-hoc assessment of the data from the POETYK PSO-1 clinical trial, looking at 2 therapies over the course of a 52-week period: deucravacitinib 6 mg on a once-per-day regimen and apremilast 30 mg twice-per-day. They had recruited adult patients with moderate-to-severe psoriasis for 6 months minimum.

The primary endpoints the team evaluated were looked into both at the 16-week mark and subsequently every 4 weeks. Those given apremilast who were shown not to be achieving PASI 50 by the 24-week mark were changed to a deucravacitinib regimen.

The clinical benefits which the investigators observed among subjects beginning treatment with 1 drug compared to the other over the course of 52 weeks was evaluated through the use of cumulative response measures.

First, the percentage of individuals able to reach PASI 75 and, second, the percentage of subjects able to reach an sPGA 0/1 with a minimum 2-point improvement from the point of baseline. These metrics were noted by the research team at the 0, 1, 2, 4-week marks. Afterward, it occurred every 4 weeks through to the 52-week mark.

The study participants were also candidates for phototherapy or systemic therapy. The research team excluded potential subjects who previously had received deucravacitinib or apremilast as therapies.

Findings

Overall, the 332 psoriasis patients who began treatment with deucravacitinib were shown to have superior overall results in terms of achieving sPGA 0/1 and PASI 75 versus the 168 individuals beginning apremilast therapy.

The deucravacitinib cohort was reported by the research team to have experienced, over the 52-week course of study, a 50% greater PASI 75 improvement rate. Additionally, the team found that the same cohort saw a 58% greater sPGA 0/1 improvement rate than those featured in the apremilast arm.

Armstrong and colleagues’ findings on this topic were noted as having remained consistent with the prior data, when assessed through the lens of evaluating based on patients’ prior exposure to systemic and biologic therapy exposure. The investigators did note limitations of their research as well.

“A limitation of this study is that the results were obtained using clinical trial data from patients with moderate to severe plaque psoriasis,” they wrote. “Therefore, these findings may not be generalizable to real-world effectiveness nor to patients with other forms of psoriasis.”

References

1. ^{Armstrong, A.W., Park, S.H., Patel, V. et al. Cumulative Benefit Over 52 Weeks With Deucravacitinib Versus Apremilast in Moderate to Severe Plaque Psoriasis: POETYK PSO-1 Post Hoc Analysis. Dermatol Ther (Heidelb) (2024). https://doi.org/10.1007/s13555-024-01201-4.}
2. ^{Armstrong AW, Gooderham M, Warren RB, et al. Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, placebo-controlled phase 3 POETYK PSO-1 trial. J Am Acad Dermatol. 2023;88(1):29–39.}