Efficacy of tyrosine-kinase-2 and phosphodiesterase-4 inhibitors for scalp psoriasis: a systematic review and meta-analysis

Abstract

Objectives

Psoriasis of the scalp is challenging to manage. The only approved oral tyrosine kinase 2 and phosphodiesterase 4 inhibitors for psoriasis are deucravacitinib and apremilast. The aim of this study was to explore their efficacy for scalp psoriasis utilizing data from randomized controlled trials.

Methods

We searched Medline, Scopus, Web of Science, CENTRAL, and ClinicalTrials.gov up to August 4, 2023. To determine risk of bias, the revised Risk of Bias assessment tool 2.0 was used. Inverse variance random effects meta-analyses were executed. Heterogeneity was assessed utilizing Q and I² statistics. Pre-determined outcomes included the proportion of participants with cleared scalp skin (Scalp Physician’s Global Assessment [ScPGA] of 0/1), mean change in Psoriasis Scalp Severity Index (PSSI), and mean improvement in Dermatology Life Quality Index (DLQI).

Results

Ten RCTs fulfilled inclusion criteria. Both apremilast (RR = 2.41, 95% CI = 2.08–2.79, Tau² = 0, I² = 0) and deucravacitinib (RR = 3.86, 95% CI = 3.02–4.94, Tau² = 0, I² = 0) were more effective in inducing ScPGA of 0/1 at 16 weeks compared to placebo. Furthermore, deucravacitinib was more effective than apremilast (RR = 1.70, 95% CI = 1.44–2.00, Tau² = 0, I² = 0). An analysis could not be executed for the rest of the outcomes.

Conclusions

Apremilast and deucravacitinib are effective for scalp psoriasis. Deucravacitinib may be more efficient in clearing the scalp.

Keywords:

• BMS-986165
• otezla
• scalp psoriasis
• localized psoriasis

Transparency

Declaration of funding

This review was not funded.

Declaration of financial/other relationships

SGT: none declared; EKK: none declared; MGG: none declared; EZ: consulting fees: Abbvie, Genesis Pharma, Leo, Novartis, Jannsen, Pharmaserv Lilly, Pfizer, Sanofi, UCB, payment or honoraria: Abbvie, Genesis Pharma, Leo, Novartis, Jannsen, Pharmaserv Lilly, Pfizer, Sanofi, UCB, support for attending meetings: Abbvie, Genesis Pharma, Novartis, Jannsen, Pharmaserv Lilly, Sanofi, UCB; DPB: lecture honoraria: Menarini Hellas, Boehringer Ingelheim, Genesis Pharma, Fresenius Kabi; congress travel and accommodation support: Hospital Iine, Pfizer, Elpen, Aenorasis Hellas.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conceptualization, SGT and DPB; methodology, MGG, SGT, and EKK; formal analysis, SGT; investigation, SGT, EKK, and MGG; data curation, SGT, EKK, and MGG; writing – original draft preparation, SGT and DPB; writing – review and editing, SGT, MGG, EKK, EZ, and DPB; visualization, SGT; supervision, DPB; project administration, DPB.

Acknowledgements

The authors would like to thank Prof. Eirini I. Rigopoulou for her critical comments.

Data availability statement

Extraction forms and extracted data analyzed are available on reasonable request from the corresponding author.