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TYK2 (Tyrosine Kinase 2) Inhibitor Pregnancy: Avoid — animal embryotoxicity data; effective contraception required during and for 4 weeks after treatment

Deucravacitinib

Brand names: Sotyktu

Adult dose

Dose: 6 mg once daily
Route: Oral
Frequency: Once daily
Max: 6 mg/day
Moderate-severe plaque psoriasis; first oral selective TYK2 inhibitor; no laboratory monitoring required for most patients

Paediatric dose

Dose: Not established N/A/kg
Route: N/A
Frequency: N/A
Max: N/A
Not licensed in paediatrics

Dose adjustments

Renal

No dose adjustment required for mild-moderate impairment; limited data in severe

Hepatic

Mild-moderate: no adjustment; severe: limited data — avoid

Paediatric weight-based calculator

Not licensed in paediatrics

Clinical pearls

  • POETYK PSO-1 and PSO-2 (Strober et al. NEJM 2023): deucravacitinib significantly superior to apremilast and placebo in PASI 75 at week 16 (53% vs 35% vs 9%) — first oral drug to demonstrate superiority over apremilast for psoriasis
  • Novel allosteric TYK2 mechanism: binds regulatory pseudokinase domain (JH2) rather than catalytic domain — highly selective for TYK2 vs JAK1/2/3; avoids the broader JAK inhibition associated with baricitinib/upadacitinib safety concerns (VTE, MACE, malignancy MHRA class warnings)
  • MHRA 2023 approved; NICE TA929 for moderate-severe plaque psoriasis in adults; no routine laboratory monitoring required — significant clinical advantage over JAK inhibitors
  • No MHRA black box equivalent to pan-JAK inhibitors — targeted TYK2 mechanism positions deucravacitinib safety profile closer to biologics than to broad JAK inhibitors
  • CYP1A2 interaction: clinically important — if patient is on theophylline or tizanidine, monitor for toxicity; caffeine metabolism also slowed (minor)

Contraindications

  • Active serious infections
  • Known hypersensitivity

Side effects

  • Nasopharyngitis
  • Upper respiratory infections
  • Acne
  • Folliculitis
  • Mouth ulcers
  • Herpes simplex reactivation
  • Nausea

Interactions

  • CYP1A2 substrates — deucravacitinib may increase levels of CYP1A2 substrates (e.g. theophylline, tizanidine); monitor
  • Live vaccines — avoid during treatment

Monitoring

  • TB and hepatitis B/C screening before initiation
  • Infection monitoring
  • Skin examination (acneiform eruptions)
  • No routine FBC/LFTs required unlike JAK inhibitors

Reference: BNFc; BNF 90; POETYK PSO-1 trial (Armstrong et al. NEJM 2023); NICE TA929; MHRA SPC Sotyktu 2023; Strober et al. NEJM 2023. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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