Deucravacitinib in plaque psoriasis: 2-year laboratory results from the phase 3 POETYK PSO program Neil J Korman,1 Thierry Passeron,2 Kenneth B Gordon,3 Yukari Okubo,4 Jerry Bagel,5 Howard Sofen,6 Richard B Warren,7 Neal Bhatia,8 Lynda Spelman,9 Kevin Winthrop,10 Lauren Hippeli,11 Renata M Kisa,11 Subhashis Banerjee,11 Diamant Thaçi12 1Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA; 2Côte d’Azur University, University Hospital of Nice, Nice, France; 3Medical College of Wisconsin, Milwaukee, WI, USA; 4Tokyo Medical University, Tokyo, Japan; 5Psoriasis Treatment Center of New Jersey, East Windsor, NJ, USA; 6UCLA School of Medicine, Los Angeles, CA, USA; 7Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK; 8Therapeutics Clinical Research, San Diego, CA, USA; 9Veracity Clinical Research, Brisbane, QLD, Australia; 10Oregon Health & Science University, Portland, OR, USA; 11Bristol Myers Squibb, Princeton, NJ, USA; 12University of Lübeck, Lübeck, Germany Presented at the Winter Clinical Dermatology Conference - Hawaii®; January 13-18, 2023; Kohala Coast, HI This is an encore of the 2022 31st EADV Congress presentation Email: Neil.Korman@UHhospitals.org Copies of this poster are for personal use only and may not be reproduced without written permission from the authors. Synopsis • Tyrosine kinase 2 (TYK2) is an intracellular enzyme that mediates signaling of cytokines (interleukin-23 and Type I interferons) involved in psoriasis pathogenesis1 • Deucravacitinib, an oral, selective, allosteric TYK2 inhibitor, is approved by the US Food and Drug Administration for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy2 • Deucravacitinib has a unique mechanism of action, the first in a new class of small molecules1 (Figure 1) • The selectivity of deucravacitinib facilitates a more targeted therapeutic approach that avoids signature laboratory changes seen with the Janus kinase (JAK) 1/2/3 inhibitors — In phase 2 and phase 3 trials (POETYK PSO-1 and PSO-2) in plaque psoriasis, deucravacitinib treatment did not result in neutropenia, elevated liver enzyme and serum creatinine levels, and dyslipidemia — adverse events that have been associated with JAK 1/2/3 inhibitors3-7 • Deucravacitinib demonstrated a robust efficacy profile, including superiority to placebo and apremilast and durability and maintenance of response, in 2 multinational phase 3 trials in patients with moderate to severe plaque psoriasis5,6,8 • Patients who completed the POETYK PSO-1 and PSO-2 trials could enroll in the ongoing POETYK long-term extension (LTE) trial Objectives • To determine whether there were any clinically relevant changes in blood laboratory parameters with up to 2 years of deucravacitinib treatment in the POETYK PSO-1, PSO-2, and LTE trials • To evaluate whether deucravacitinib treatment elicits changes in the blood that are known to occur with JAK 1/2/3 inhibitors Methods Study designs • POETYK PSO-1 (NCT03624127) and PSO-2 (NCT03611751) were 52-week, multinational, phase 3, double-blind trials that randomized patients with moderate to severe plaque psoriasis 2:1:1 to deucravacitinib 6 mg once daily, placebo, or apremilast 30 mg twice daily (Figure 2) • At Week 52, eligible patients were able to enroll in the POETYK LTE trial (NCT04036435) and receive open-label deucravacitinib 6 mg once daily for up to 2 years Figure 2. POETYK PSO-1, PSO-2, and LTE study designs 100 POETYK PSO-1 and PSO-2 Deucravacitinib 6 mg QDPlacebo (n = 166) Deucravacitinib 6 mg QD Apremilast 30 mg BID Titrate*P O E T Y K P SO -1 1 :2 :1 r an d o m iz at io n Deucravacitinib 6 mg QD (n = 332) Apremilast 30 mg BIDa (n = 168) Deucravacitinib 6 mg QDPlacebo (n = 255) Deucravacitinib 6 mg QD (n = 511) Deucravacitinib 6 mg QD3x ULN on Days 1 and 8; total bilirubin levels remained in the normal range. The patient discontinued placebo and ALT levels improved. cPatient who received deucravacitinib during Weeks 0–16 had ALT and AST elevations ≥3x ULN and bilirubin elevation >2x ULN on Day 58. Deucravacitinib treatment was discontinued and ALT, AST, and bilirubin levels improved. ALT, alanine aminotransferase; AST, aspartate aminotransferase; CPK, creatine phosphokinase; EAIR, exposure-adjusted incidence rate; LTE, long-term extension; PY, person-years; ULN, upper limit of normal. Conclusions • In the large, phase 3 POETYK PSO-1, PSO-2, and LTE trials in patients with plaque psoriasis, no trends or clinically meaningful changes in multiple hematologic, lipid, and chemistry parameters were observed in 1519 patients with 2482.0 PY of deucravacitinib exposure — Signature laboratory changes associated with JAK 1/2/3 inhibitors were not observed over 2 years of deucravacitinib exposure • CTCAE grade ≥3 laboratory abnormalities and treatment discontinuations due to laboratory abnormalities in deucravacitinib-treated patients were rare, and were comparable to incidence rates observed with placebo and apremilast over the first 52 weeks • Deucravacitinib, a once-daily oral drug, has the potential to become a treatment of choice and new standard of care for patients who require systemic therapy for their moderate to severe plaque psoriasis References 1. Burke JR, et al. Sci Transl Med. 2019;11:eaaw1736. 2. SOTYKTU™ (deucravacitinib) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; September 2022. 3. Papp K, et al. N Engl J Med. 2018;379:1313-1321. 4. Winthrop KL. Nat Rev Rheumatol. 2017; 13:234-243. 5. Armstrong AW, et al. J Am Acad Dermatol. 2023;88:29-39. 6. Strober B, et al. J Am Acad Dermatol. 2023;88:40-51. 7. Thaçi D, et al. Presented at the 30th EADV Congress; September 29–October 2, 2021. 8. Warren RB, et al. Presented at the EADV Spring Symposium; 12–14 May 2022; Ljubljana, Slovenia. 9. Wrobleski ST, et al. J Med Chem. 2019;62:8973-8995. Acknowledgments • This study was sponsored by Bristol Myers Squibb • Writing and editorial assistance was provided by Liz Rockstein, PhD, of Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, funded by Bristol Myers Squibb Disclosures • NJK: Advisory board and consulting fees: AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Leo Pharma, Novartis, Principia, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB; Grant support/principal investigator: AbbVie, Amgen, Argenx, Bristol Myers Squibb, Celgene, Chemocentryx, Eli Lilly, Galderma, Kyowa Kirin, Leo Pharma, Menlo, Principia, Prothena, Rhizen, Syntimmune, Trevi, and XBiotech; Speaker: AbbVie, Eli Lilly, Janssen, Novartis, Regeneron, and Sanofi Genzyme • TP: Advisory board and consulting fees: AbbVie, Almirall, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galderma, Incyte, Janssen, Leo Pharma, Novartis, Pfizer, Sanofi Genzyme, Sun Pharma, and UCB • KBG: Grant support and consulting fees: AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, and UCB; Consulting fees: Almirall, Amgen, Dermira, Leo Pharma, Pfizer, and Sun Pharma • YO: Research grants: Eisai, Maruho, Shiseido, and Torii; Current consulting/advisory board agreements: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Janssen, and Sun Pharma; Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eisai, Eli Lilly, Janssen Pharma, Jimro, Kyowa Kirin, Leo Pharma, Maruho, Novartis, Pfizer, Sanofi, Sun Pharma, Taiho, Tanabe-Mitsubishi, Torii, and UCB; Clinical trials: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Leo Pharma, Maruho, Pfizer, Sun Pharma, and UCB • JB: Research funds payable to the Psoriasis Treatment Center of New Jersey: AbbVie, Amgen, Arcutis, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, CorEvitas’ (Corrona) Psoriasis Registry, Dermavant, Dermira/UCB, Eli Lilly, Glenmark, Janssen Biotech, Kadmon, Leo Pharma, Lycera, Menlo Therapeutics, Novartis, Pfizer, Regeneron, Sun Pharma, Taro, and Valeant; Consultant: AbbVie, Amgen, Celgene, Eli Lilly, Janssen Biotech, Novartis, Sun Pharma, and Valeant; Speaker: AbbVie, Celgene, Eli Lilly, Janssen Biotech, and Novartis • HS: Clinical investigator: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Janssen, Leo Pharma, Novartis, and Sun Pharma • RBW: Research grants: AbbVie, Almirall, Amgen, Celgene, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, and UCB; Consulting fees: AbbVie, Almirall, Amgen, Biogen, Boehringer Ingelheim, Celgene, DICE Therapeutics, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Sanofi, UCB, and UNION • NB: Advisor and consultant investigator: AbbVie, Almirall, Arcutis, Arena, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, InCyte, ISDIN, Johnson & Johnson, Leo Pharma, Lilly, Ortho, Pfizer, Regeneron, Sanofi, Stemline, and Sun Pharma; Investigator: Arcutis, Biofrontera, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, Galderma, Leo Pharma, Lilly, and Ortho • LS: Consultant, paid investigator, and/or speaker: AbbVie, Amgen, Anacor, Ascend, Astellas, AstraZeneca, Blaze Bioscience, Bristol Myers Squibb, Boehringer Ingelheim, Botanix, Celgene, Dermira, Eli Lilly, Galderma, Genentech, GlaxoSmithKline, Hexima, Janssen, Leo Pharma, Mayne, MedImmune, Merck, Merck-Serono, Novartis, Otsuka, Pfizer, Phosphagenics, Photon MD, Regeneron, Roche, Samumed, Sanofi Genzyme, SHR, Sun Pharma ANZ, Trius, UCB, and Zai Lab • KW: Consulting: AbbVie, AstraZeneca, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Novartis, Pfizer, Regeneron, Roche, Sanofi, and UCB; Research: Bristol Myers Squibb and Pfizer • LH, RMK, and SB: Employees and shareholders: Bristol Myers Squibb • DT: Grant/research support, consultant, scientific advisory board, and speakers bureau: AbbVie, Almirall, Amgen, Biogen Idec, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Galderma, Janssen-Cilag, Leo Pharma, Novartis, Pfizer, Regeneron, Roche, Sandoz-Hexal, Sanofi, Target-Solution, and UCB Figure 1. Mechanism of action of deucravacitinib • ≥100-fold greater selectivity for TYK2 vs JAK 1/3 • ≥2000-fold greater selectivity for TYK2 vs JAK 2 Deucravacitinib (allosteric inhibitor class) Unique TYK2 regulatory domain Catalytic domain (highly conserved across JAK family) ATP-binding active site (approved JAK inhibitor class) TYK2 Selectivity in cells1,9: ATP, adenosine 5′-triphosphate; JAK, Janus kinase; TYK2, tyrosine kinase 2. Table 1. Baseline patient demographics and disease characteristics Parameter POETYK PSO-1 + PSO-2 + LTE Deucravacitinib (N = 1519) Age, mean (SD), y 46.6 (13.4) Weight, mean (SD), kg 90.6 (21.6) Body mass index, mean (SD), kg/m2 30.5 (6.8) Female, n (%) 493 (32.5) Race, n (%) White 1325 (87.2) Asian 153 (10.1) Black or African American 23 (1.5) Other 18 (1.2) Age at disease onset, mean (SD), y 28.8 (14.9) Disease duration, mean (SD), y 18.7 (12.7) PASI, mean (SD) 21.1 (8.1) sPGA, n (%) 3 (moderate) 1211 (79.7) 4 (severe) 308 (20.3) BSA involvement, mean (SD), % 26.2 (15.8) BSA, body surface area; LTE, long-term extension; PASI, Psoriasis Area and Severity Index; SD, standard deviation; sPGA, static Physician’s Global Assessment.