Impact of Deucravacitinib on Scalp Psoriasis in a Real-world Prospective Cohort Study in the United States

Background: Real-world data indicate that patients with psoriasis (PsO) affecting the scalp, nails, palms, soles, and genitals report worse patient-reported outcomes (PROs) than those without PsO involvement in these special areas, despite having the same level of disease severity. Deucravacitinib is the first oral tyrosine kinase 2 inhibitor approved by the US Food and Drug Administration (FDA) for moderate-to-severe plaque psoriasis. Phase IV scalp-specific clinical trials have shown that deucravacitinib was efficacious across multiple efficacy endpoints. However, real-world evidence is limited for patients with psoriasis in difficult-to-treat areas, such as the scalp. Objective: The goal of this PRO study is to understand the impact of deucravacitinib on improvement of PsO signs and symptoms among patients with scalp PsO in the real world. Methods: Patients were recruited from dermatology offices of a U.S practice group, through a patient support program for deucravacitinib, and online from the FORWARD registry website. Patients were enrolled between August 2023 and November 2024. Inclusion criteria were adult patients initiating deucravacitinib ≤14 days of survey enrollment and continuation of deucravacitinib at 6-month follow up. We descriptively report demographics, disease characteristics, and comorbidities for participants at enrollment as well as mean change in key PROs and patient-reported psoriasis severity at 6 months in the subset of patients with scalp psoriasis. Psoriasis Symptoms and Signs Diary (PSSD) score was the primary outcome (range 0-100). All patients also completed a Dermatology Life Quality Index (DLQI) and patients with scalp PsO completed scalp-specific questions including the Scalp Specific Itch (SS-itch) numeric rating scale (NRS), scalp specific pain (SS-pain) NRS, and the scalp specific flaking (SS-flaking, NRS). Results: Among 306 patients with psoriasis initiating deucravacitinib, 219 (71.6%) reported scalp psoriasis. Of these, sixty patients (27.4%) completed a 6-month follow up, and 39 of these (65.0%) were persistent on therapy at 6 months. At baseline, the mean PSSD was higher among those with scalp psoriasis compared to those without reported scalp psoriasis (34.1 vs 25.8). At 6-month follow up, the mean change in PSSD among those with scalp psoriasis was -19.2 (SD: 27.6). Mean DLQI at enrollment among those with scalp psoriasis was 8.5 (SD: 4.7) and change in DLQI at 6 month follow up was -4.5 (SD: 5.4). Scalp itch (0-10) at baseline was 4.1 (SD: 3.0) and mean change was -1.9 (SD: 2.7). Mean scalp flaking (0-10) at baseline was 4.7 (SD: 3.0) and mean change was -2.0 (SD: 3.2). Mean scalp pain at baseline was 1.8 (SD: 2.8) and mean change was -0.3 (SD: 2.2). Conclusions: Deucravacitinib was associated with improvements in scalp psoriasis and patient-reported outcomes of disease impact and quality of life in a real-world setting.