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PSO-1 and PSO-21-4

POETYK PSO-1 and POETYK PSO-2 Clinical Trials Graphics
POETYK PSO-1 Clinical Trials Graphics
POETYK PSO-2 Clinical Trials Graphics
  • Apremilast was titrated from 10 mg QD to 30 mg BID over the first 5 days of dosing.2,4
  • Upon relapse (>50% loss of Week-24 PASI percentage improvement from baseline), patients were switched to SOTYKTU 6 mg QD; due to a programming error, however, these patients continued on placebo until Week 52.5

Study design1

Key eligibility criteria1

  • Adults with moderate-to-severe plaque psoriasis who were eligible for systemic therapy or phototherapy
  • PASI ≥12, sPGA ≥3, BSA involvement ≥10%

Co-primary endpoints1

  • Proportion of patients who achieved the following responses vs placebo at Week 16:
    • At least a 75% improvement in PASI scores from baseline (PASI 75)
    • sPGA score of 0 (clear) or 1 (almost clear)

Select key secondary endpoints1

  • Proportion of patients who achieved the following responses vs apremilast:
    • At Week 16 and Week 24: PASI 75, PASI 90
    • At Week 16: ss-PGA score of 0 (clear) or 1 (almost clear)
  • Proportion of patients who achieved the following responses vs placebo
    • At Week 16: ss-PGA score of 0 (clear) or 1 (almost clear)
  • Statistical significance was not met for the following key secondary endpoints1,2,4
    • PGA-F 0/1 (PGA-F score of clear or minimal disease) vs placebo (BL ≥3) at Week 16, PSSD symptom score of 0 vs apremilast (BL ≥1) at Week 16
  • BID=twice daily; BL=baseline; BSA=body surface area; PASI 50=≥50% reduction from baseline in PASI; PASI 75=≥75% reduction from baseline PASI; PASI 90=≥90% reduction from baseline PASI; QD=once daily; sPGA=static Physician's Global Assessment; ss-PGA=scalp-specific Physician's Global Assessment; PGA-F=Physician's Global Assessment of Fingernail Psoriasis; PSSD=Psoriasis Symptoms and Signs Diary.

POETYK PSO-LTE:

Long-term extension study1-7

Phase 3 trials and long-term extension (LTE) study graphic
Phase 3 trials and long-term extension (LTE) study graphic
  • Apremilast was titrated from 10 mg QD to 30 mg BID over the first 5 days of dosing.2,4
  • Upon relapse (≥50% loss of Week 24 PASI percentage improvement from baseline), patients were switched to SOTYKTU 6 mg QD; due to a programming error, however, these patients continued on placebo until Week 52.5
  • Safety data through 3 years and efficacy data through 148 weeks. The cutoff date of June 15, 2022.7

Study design

  • Patients who completed treatment through Week 52 in either POETYK PSO-1 or PSO-2 were eligible to enroll in an optional LTE and be switched to open-label SOTYKTU 6 mg once daily5
  • A total of 1519 patients received ≥1 dose of SOTYKTU across the parent trials and the LTE including 1364 patients in PSO-1/PSO-2 and 1221 patients in the LTE5
  • Exposure during Weeks 0-52 of PSO-1/PSO-2 was 969.0 PY, with an additional 2325.3 PY of exposure during the LTE5,7‡
  • 1178 (77.6%) patients had >12 months of total SOTYKTU exposure and 341 (22.4%) patients had >36 months of total SOTYKTU exposure throughout POETYK PSO-1, PSO-2, and PSO-LTE7
  • LTE=long-term extension; PY=patient-years.

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once-daily dosing

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

SOTYKTU is contraindicated in patients with a history of hypersensitivity reaction to deucravacitinib or to any of the excipients in SOTYKTU.

WARNINGS AND PRECAUTIONS

Hypersensitivity: Hypersensitivity reactions such as angioedema have been reported. If a clinically significant hypersensitivity reaction occurs, institute appropriate therapy and discontinue SOTYKTU.

Infections: SOTYKTU may increase the risk of infections. Serious infections have been reported in patients with psoriasis who received SOTYKTU. The most common serious infections reported with SOTYKTU included pneumonia and COVID-19. Avoid use of SOTYKTU in patients with an active or serious infection. Consider the risks and benefits of treatment prior to initiating SOTYKTU in patients:

  • with chronic or recurrent infection
  • who have been exposed to tuberculosis
  • with a history of a serious or an opportunistic infection
  • with underlying conditions that may predispose them to infection.

Closely monitor patients for the development of signs and symptoms of infection during and after treatment. A patient who develops a new infection during treatment should undergo prompt and complete diagnostic testing, have appropriate antimicrobial therapy initiated and be closely monitored. Interrupt SOTYKTU if a patient develops a serious infection. Do not resume SOTYKTU until the infection resolves or is adequately treated.

Viral Reactivation

Herpes virus reactivation (e.g., herpes zoster, herpes simplex) was reported in clinical trials with SOTYKTU. Through Week 16, herpes simplex infections were reported in 17 patients (6.8 per 100 patient-years) treated with SOTYKTU, and 1 patient (0.8 per 100 patient-years) treated with placebo. Multidermatomal herpes zoster was reported in an immunocompetent patient. During PSO-1, PSO-2, and the open-label extension trial, the majority of patients who reported events of herpes zoster while receiving SOTYKTU were under 50 years of age. The impact of SOTYKTU on chronic viral hepatitis reactivation is unknown. Consider viral hepatitis screening and monitoring for reactivation in accordance with clinical guidelines before starting and during therapy with SOTYKTU. If signs of reactivation occur, consult a hepatitis specialist. SOTYKTU is not recommended for use in patients with active hepatitis B or hepatitis C.

Tuberculosis (TB): In clinical trials, of 4 patients with latent TB who were treated with SOTYKTU and received appropriate TB prophylaxis, no patients developed active TB (during the mean follow-up of 34 weeks). One patient, who did not have latent TB, developed active TB after receiving 54 weeks of SOTYKTU. Evaluate patients for latent and active TB infection prior to initiating treatment with SOTYKTU. Do not administer SOTYKTU to patients with active TB. Initiate treatment of latent TB prior to administering SOTYKTU. Consider anti-TB therapy prior to initiation of SOTYKTU in patients with a past history of latent or active TB in whom an adequate course of treatment cannot be confirmed. Monitor patients for signs and symptoms of active TB during treatment.

Malignancy including Lymphomas: Malignancies, including lymphomas, were observed in clinical trials with SOTYKTU. Consider the benefits and risks for the individual patient prior to initiating or continuing therapy with SOTYKTU, particularly in patients with a known malignancy (other than a successfully treated non-melanoma skin cancer) and patients who develop a malignancy when on treatment with SOTYKTU.

Rhabdomyolysis and Elevated CPK: Treatment with SOTYKTU was associated with an increased incidence of asymptomatic creatine phosphokinase (CPK) elevation and rhabdomyolysis compared to placebo. Discontinue SOTYKTU if markedly elevated CPK levels occur or myopathy is diagnosed or suspected. Instruct patients to promptly report unexplained muscle pain, tenderness or weakness, particularly if accompanied by malaise or fever.

Laboratory Abnormalities: Treatment with SOTYKTU was associated with increases in triglyceride levels. Periodically evaluate serum triglycerides according to clinical guidelines during treatment. SOTYKTU treatment was associated with an increase in the incidence of liver enzyme elevation compared to placebo. Evaluate liver enzymes at baseline and thereafter in patients with known or suspected liver disease according to routine management. If treatment-related increases in liver enzymes occur and drug-induced liver injury is suspected, interrupt SOTYKTU until a diagnosis of liver injury is excluded.

Immunizations: Prior to initiating therapy with SOTYKTU, consider completion of all age-appropriate immunizations according to current immunization guidelines including prophylactic herpes zoster vaccination. Avoid use of live vaccines in patients treated with SOTYKTU. The response to live or non-live vaccines has not been evaluated.

Potential Risks Related to JAK Inhibition: It is not known whether tyrosine kinase 2 (TYK2) inhibition may be associated with the observed or potential adverse reactions of Janus Kinase (JAK) inhibition. In a large, randomized, postmarketing safety trial of a JAK inhibitor in rheumatoid arthritis (RA), patients 50 years of age and older with at least one cardiovascular risk factor, higher rates of all-cause mortality, including sudden cardiovascular death, major adverse cardiovascular events, overall thrombosis, deep venous thrombosis, pulmonary embolism, and malignancies (excluding non-melanoma skin cancer) were observed in patients treated with the JAK inhibitor compared to those treated with TNF blockers. SOTYKTU is not approved for use in RA.

ADVERSE REACTIONS

Most common adverse reactions (≥1% of patients on SOTYKTU and more frequently than with placebo) include upper respiratory infections, blood creatine phosphokinase increased, herpes simplex, mouth ulcers, folliculitis and acne.

SPECIFIC POPULATIONS

Pregnancy: Available data from case reports on SOTYKTU use during pregnancy are insufficient to evaluate a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Report pregnancies to the Bristol-Myers Squibb Company’s Adverse Event reporting line at 1-800-721-5072.

Lactation: There are no data on the presence of SOTYKTU in human milk, the effects on the breastfed infant, or the effects on milk production. SOTYKTU is present in rat milk. When a drug is present in animal milk, it is likely that the drug will be present in human milk. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for SOTYKTU and any potential adverse effects on the breastfed infant from SOTYKTU or from the underlying maternal condition.

Hepatic Impairment: SOTYKTU is not recommended for use in patients with severe hepatic impairment.

SOTYKTU is available in 6 mg tablets.

INDICATION

SOTYKTU® (deucravacitinib) is indicated for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy.

Limitations of Use:

SOTYKTU is not recommended for use in combination with other potent immunosuppressants.

Please see U.S. Full Prescribing Information, including Medication Guide, for SOTYKTU.

References:

  1. SOTYKTU [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2022.
  2. Armstrong AW, Gooderham M, Warren RB, et al. Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, placebo-controlled phase 3 POETYK PSO-1 trial. J Am Acad Dermatol. 2023;88(1):29-39.
  3. Armstrong A, Gooderham M, Warren RB, et al. Efficacy and safety of deucravacitinib, an oral, selective tyrosine kinase 2 (TYK2) inhibitor, compared with placebo and apremilast in moderate to severe plaque psoriasis: results from the POETYK PSO-1 study. Oral presentation at American Academy of Dermatology Virtual Meeting Experience (VMX); April 23-25, 2021; Virtual Meeting. Session S033.
  4. Strober B, Thaçi D, Sofen H, et al. Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, phase 3 Program fOr Evaluation of TYK2 inhibitor psoriasis second trial. J Am Acad Dermatol. 2023;88(1):40-51.
  5. Warren RB, Sofen H, Imafuku S, et al. Deucravacitinib long-term efficacy and safety in plaque psoriasis: 2-year results from the phase 3 POETYK PSO program. Poster presented at: European Academy of Dermatology & Venereology (EADV) Spring Symposium; May 12-14, 2022: Ljubljana, Slovenia. Poster P465.
  6. ClinicalTrials.gov. NCT04036435. https://clinicaltrials.gov/ct2/show/NCT04036435. Accessed June 8, 2023.
  7. Armstrong AW, Lebwohl M, Warren RB, et al. Deucravacitinib in plaque psoriasis: 3-year safety and efficacy results from the phase 3 POETYK PSO-1 and PSO-2 trials. Oral presentation at: European Academy of Dermatology & Venereology (EADV) Congress; October 11-14, 2023; Berlin, Germany. Poster FC.02.7
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References:

  1. SOTYKTU [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2022.
  2. Armstrong AW, Gooderham M, Warren RB, et al. Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, placebo-controlled phase 3 POETYK PSO-1 trial. J Am Acad Dermatol. 2023;88(1):29-39.
  3. Armstrong A, Gooderham M, Warren RB, et al. Efficacy and safety of deucravacitinib, an oral, selective tyrosine kinase 2 (TYK2) inhibitor, compared with placebo and apremilast in moderate to severe plaque psoriasis: results from the POETYK PSO-1 study. Oral presentation at American Academy of Dermatology Virtual Meeting Experience (VMX); April 23-25, 2021; Virtual Meeting. Session S033.
  4. Strober B, Thaçi D, Sofen H, et al. Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, phase 3 Program fOr Evaluation of TYK2 inhibitor psoriasis second trial. J Am Acad Dermatol. 2023;88(1):40-51.
  5. Warren RB, Sofen H, Imafuku S, et al. Deucravacitinib long-term efficacy and safety in plaque psoriasis: 2-year results from the phase 3 POETYK PSO program. Poster presented at: European Academy of Dermatology & Venereology (EADV) Spring Symposium; May 12-14, 2022: Ljubljana, Slovenia. Poster P465.
  6. ClinicalTrials.gov. NCT04036435. https://clinicaltrials.gov/ct2/show/NCT04036435. Accessed June 8, 2023.
  7. Armstrong AW, Lebwohl M, Warren RB, et al. Deucravacitinib in plaque psoriasis: 3-year safety and efficacy results from the phase 3 POETYK PSO-1 and PSO-2 trials. Oral presentation at: European Academy of Dermatology & Venereology (EADV) Congress; October 11-14, 2023; Berlin, Germany. Poster FC.02.7
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