Deucravacitinib

How it works

It allosterically inhibits TYK2 by binding its regulatory domain, blocking signalling of interleukin-23, interleukin-12 and type I interferons that drive psoriatic inflammation.

Prescribing in practice

• Screen for and treat latent tuberculosis and other active or chronic infections before starting, as TYK2 inhibition increases infection risk.
• Live vaccines should be avoided during treatment, and immunisations brought up to date beforehand.
• Although a selective TYK2 inhibitor, the recognised class warnings for Janus-kinase pathway agents (including malignancy and major cardiovascular and thrombotic events) should be considered in at-risk patients.

Monitoring

Monitor for signs of infection throughout treatment and consider liver function and lipid assessment in line with the current prescribing references.

Counselling the patient

• Tell your team about any signs of infection such as fever, cough or persistent sores.
• Avoid live vaccines and let healthcare staff know you take this medicine before any immunisation.
• Take it as a whole tablet and do not crush or split it.

Evidence & guidelines

Efficacy over placebo and an active comparator in plaque psoriasis was shown in the POETYK PSO phase 3 trials, and NICE has appraised its use in moderate-to-severe disease.