Effects of Switching From Deucravacitinib to Tildrakizumab in Psoriasis: A 28-Week Real-World Study

Deucravacitinib, a tyrosine kinase 2 inhibitor, has shown efficacy and tolerability in moderate-to-severe psoriasis. However, evidence on switching from deucravacitinib to an interleukin-23 inhibitor is limited.

We examined outcomes after switching from deucravacitinib to the anti-interleukin-23p19 antibody tildrakizumab.

We conducted a single-center retrospective study of 15 adults (aged ≥18 years) with psoriasis who showed an insufficient response to ≥16 weeks of deucravacitinib 6 mg. Insufficient response was defined as < 75% improvement of psoriasis area and severity index (PASI) from baseline, or a static physician's global assessment (sPGA) score of ≥2. After switching, patients received tildrakizumab 100 mg at weeks 0 and 4, followed by every 12 weeks. We assessed PASI, sPGA, and the dermatology life quality index (DLQI) at weeks 4, 16, and 28.

At week 28, the mean percent reductions from baseline were 89.0% for PASI and 77.2% for DLQI. The achievement rates of PASI 75, PASI 90, PASI 100, and sPGA 0/1 at week 28 were 88.9%, 55.6%, 44.4%, and 77.8%, respectively. The achievement rates of PASI ≤3, PASI ≤2, PASI ≤1, and DLQI 0/1 at week 28 were 88.9%, 77.8%, 55.6%, and 50.0%, respectively. Three treatment-related adverse events (AEs) occurred; eczema in 2 patients (13.3%) and arthralgia in 1 patient (6.7%).

These preliminary findings suggest that tildrakizumab may be a treatment option for patients with an insufficient response to deucravacitinib.