Efficacy and Safety of Deucravacitinib for Cutaneous Lupus Erythematosus

Background: Cutaneous lupus erythematosus (CLE) is an autoimmune skin disease for which patients require additional treatment options. Deucravacitinib is the first oral, allosteric inhibitor of tyrosine kinase 2 (TYK2). It is approved for treating psoriasis, but ongoing trials are being conducted to explore its efficacy for systemic lupus erythematosus (SLE). Amidst these trial results and sparse case reports are instances of deucravacitinib treating CLE. Aims: We aimed to perform a comprehensive literature review to analyse cases of CLE treated with deucravacitinib. Methods: On July 22nd, 2024, the following databases were searched for articles: PubMed, Cochrane Library, MEDLINE, EMBASE, and Scopus. The search terms used were “deucravacitinib” and “lupus.” Included articles were clinical studies of male or female patients of any age with CLE who received deucravacitinib and were published online, in print, or press, in any language. Two reviewers performed the title and abstract review, as well as data extraction. The following outcomes were collected from each study: study type, demographic data (including number of subjects, age, gender, and ethnicity), intervention, efficacy data, and safety data. Results: Five studies met the criteria for inclusion and included 367 patients, with a mean age of 40.3, 92% female, and race as follows: White = 64%, Hispanic or Latino = 34.6%, Asian = 12.3%, Other or not reported = 10.9%, Black = 9%, American Indian or Alaska Native = 3.8%. Four studies were case reports, while one study was a randomised controlled trial. Deucravacitinib was found to lead to improvement or remission of CLE in as little as 1 month. The most common adverse events reported were upper respiratory tract infection (14.2% vs. 8.9%; treatment vs. placebo groups, respectively), nasopharyngitis (10.6% vs. 12.2%; treatment vs. placebo groups, respectively), headache (9.6% vs. 16.7%; treatment vs. placebo groups, respectively), and urinary tract infections (8.5% vs. 3.3%; treatment vs. placebo groups, respectively). Only 7.7% of all participants chose to discontinue deucravacitinib due to adverse effects. Conclusion: While reports are scarce, initial data suggest that deucravacitinib is a safe and effective treatment for CLE. These findings can also be of great significance to clinicians for the management of refractory cases of CLE.