Acneiform Eruption with Deucravacitinib: Systematic Review and Meta-Analysis

Deucravacitinib, an oral selective tyrosine kinase 2 (TYK2) inhibitor, is an effective treatment for chronic plaque psoriasis. Its use is widening to treat other autoinflammatory conditions, but acneiform eruptions have been increasingly reported. The objective was to quantify the incidence of acneiform eruptions with deucravacitinib and compare odds versus placebo, with exploratory analyses by dose and indication. A search of Medline, Embase, and CENTRAL was made for interventional and observational studies. Primary outcome was incidence of acneiform eruption (acne, folliculitis, dermatitis acneiforme, rosacea). Random-effects meta-analysis pooled proportions and odds ratios (OR) was performed. Of 672 records, 14 studies met inclusion. Overall, 467/5,280 (8.8%) developed an acneiform eruption (acne 71.3%, folliculitis 23.3%, dermatitis acneiforme 3.2%, rosacea 2.1%). Across eight controlled studies, pooled incidence was 6.4% (95% CI: 0.05 - 0.09; I2 = 74.9%). Events occurred in 145/2,539 (5.71%) on deucravacitinib versus 9/1,070 (0.84%) controls; pooled OR 4.56 (95% CI 2.28-9.12; I2=9.4%). Discontinuations for acneiform events were uncommon (7/3,317; 0.21%). Dose- and indication-specific analyses suggested higher odds at greater total daily doses and in psoriasis/inflammatory bowel disease. In conclusion, acneiform eruptions are a frequent cutaneous adverse event with deucravacitinib and occur significantly more often than with placebo yet rarely lead to discontinuation.