Autoimmun Rev. 2026 Nov 12:104251. doi: 10.1016/j.autrev.2026.104251. Online ahead of print.
ABSTRACT
BACKGROUND: Deucravacitinib is a first-in-class selective TYK2 inhibitor approved for plaque psoriasis. No comprehensive systematic review and meta-analysis (SRMA) has evaluated its multidomain efficacy and safety in psoriatic arthritis (PsA).
METHODS: We conducted a PRISMA compliant SRMA comparing deucravacitinib 6 mg once daily versus placebo in adults with active PsA. Effect sizes were expressed as odds ratios (OR) or mean differences (MD) with 95% confidence intervals. Heterogeneity was assessed using the I2 statistic and the certainty of evidence was graded using the GRADE framework.
RESULTS: Three RCTs (N = 1430) were included, all rated low risk of bias. Deucravacitinib significantly outperformed placebo across all ACR response thresholds (ACR20: OR 2.07 [1.68-2.56]; ACR50: OR 2.13 [1.63-2.79]; ACR70: OR 2.42 [1.61-3.63]). Significant benefits were observed across composite disease activity indices including DAS28-CRP remission (OR 2.14 [1.62-2.82]) and DAPSA remission (OR 3.50 [2.04-6.00]), as well as minimal disease activity. Dermatological outcomes showed large treatment effects though with substantial heterogeneity. Significant improvements were also demonstrated in physical function, dactylitis resolution, disease-specific quality of life, fatigue, pain interference, and all four WPAI domains. The safety profile was comparable to placebo, with no significant differences in total adverse events (OR 1.30 [0.79-2.16]), serious adverse events (OR 1.00 [0.45-2.20]), or gastrointestinal events (OR 0.73 [0.42-1.25]).
CONCLUSIONS: Deucravacitinib 6 mg once daily demonstrates consistent, multidomain superiority over placebo in active PsA at 16 weeks without excess adverse event burden. Head-to-head trials and longer-term data are needed to define its position in the treatment algorithm.
PMID:43020362 | DOI:10.1016/j.autrev.2026.104251