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

Background: 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. Objective: We examined outcomes after switching from deucravacitinib to the anti-interleukin-23p19 antibody tildrakizumab. Methods: 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. Results: 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%). Conclusions: These preliminary findings suggest that tildrakizumab may be a treatment option for patients with an insufficient response to deucravacitinib.