Efficacy of tyrosine-kinase-2 and phosphodiesterase-4 inhibitors for scalp psoriasis: a systematic review and meta-analysis

AbstractObjectives Psoriasis of the scalp is challenging to manage. The only approved oral tyrosine kinase 2 and phosphodiesterase 4 inhibitors for psoriasis are deucravacitinib and apremilast. The aim of this study was to explore their efficacy for scalp psoriasis utilizing data from randomized controlled trials.Methods We searched Medline, Scopus, Web of Science, CENTRAL and ClinicalTrials.gov up to 4th of August 2023. To determine risk of bias, the revised Risk of Bias assessment tool 2.0 was used. Inverse variance random effects meta-analyses were executed. Heterogeneity was assessed utilizing Q and I2 statistics. Pre-determined outcomes included the proportion of participants with cleared scalp skin (Scalp Physician’s Global Assessment [ScPGA] of 0/1), mean change in Psoriasis Scalp Severity Index (PSSI), and mean improvement in Dermatology Life Quality Index (DLQI).Results Ten RCTs fulfilled inclusion criteria. Both apremilast (RR 2.41, 95% CI 2.08 to 2.79, Tau2=0, I2=0) and deucravacitinib (RR 3.86, 95% CI 3.02 to 4.94, Tau2=0, I2=0) were more effective in inducing ScPGA of 0/1 at 16 weeks compared to placebo. Furthermore, deucravacitinib was more effective than apremilast (RR 1.70, 95% CI 1.44 to 2.00, Tau2=0, I2=0). An analysis could not be executed for the rest of the outcomes.Conclusions Apremilast and deucravacitinib are effective for scalp psoriasis. Deucravacitinib may be more efficient in clearing the scalp.Keywords: BMS-986165otezlascalp psoriasislocalized psoriasisDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also.