Reviews/Psoriasis Psoriatic Arthritis/Deucravacitinib versus apremilast PASI 75
Pso SM · PSA-SM-01 · v2
Borderline: within 4 points of the Established/Likely boundary, so a re-grade could land either side.
Two large, well-designed head-to-head trials directly compared deucravacitinib against apremilast in people with moderate-to-severe plaque psoriasis and measured how many reached a 75% improvement in their psoriasis score at week 16. In both trials more people on deucravacitinib hit that mark than on apremilast [1][2], and the difference was statistically significant. A separate analysis in Japanese patients pointed the same way [4], and related measures of skin clearance showed the same advantage [7][8]. Because the comparison is direct, in the right patients, at the right endpoint, and consistent across trials, the panel treated the result as well-supported. The main caution is that every confirmatory trial came from a single drug maker's POETYK program, with no independent replication.
The corpus contains two pivotal phase 3 head-to-head RCTs in which deucravacitinib produced higher PASI 75 rates than apremilast at week 16: 58.4% versus 35.1% [1] and 53.0% versus 39.8% with P=.0004 versus apremilast [2]. A Japanese subgroup of a global phase 3 trial is directionally concordant, with PASI 75 numerically higher for deucravacitinib than apremilast at week 16 (78.1% vs 23.5%) [4]. Adjacent absolute-PASI endpoints show the same direction of benefit, including significantly greater mean PASI reductions versus apremilast [7] and a mean percent reduction of -77.1% versus -50.2% (P<0.0001) at week 24 [8]. All of these results originate from the same POETYK trial program. The contested point: The evidence does not divide on direction or magnitude; every relevant data point favours deucravacitinib. It divides only on independence: all confirmatory head-to-head data derive from one sponsor's POETYK program ([1],[2],[4],[7],[8]), with no external replication of the deucravacitinib-versus-apremilast comparison.
All 9 papers behind this claim with their DOIs and what each does to it, the panel’s arbitration, the evidence gap map and the open research questions. Free, and sent to your inbox.
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One reviewer's only job is to attack the finding. The challenges below were weighed before the grade was set.
All confirmatory head-to-head evidence originates from a single sponsor's POETYK program ([1],[2],[4],[5],[7],[8]); there is no independent replication of the deucravacitinib-versus-apremilast comparison.
In [1] the reported P<.0001 is pooled 'versus placebo or apremilast'; a separate apremilast-specific p-value is not stated in the abstract, though [2] provides an explicit P=.0004 versus apremilast.
Where it remains uncertain. Every confirmatory head-to-head result comes from the single-sponsor POETYK program ([1],[2],[4],[7],[8]), with no independent replication.
Aleatory
The Japanese subgroup [4] is described as numerically higher and is not powered for the apremilast comparison, so chance variation cannot be excluded within that subset.
Epistemic
All confirmatory head-to-head evidence originates from a single sponsor's POETYK program ([1],[2],[4],[7],[8]); no external trial in the corpus tests the same comparison.
Inferential
Papers [7] and [8] report absolute PASI thresholds and mean PASI reduction rather than PASI 75 response, so their support for the claimed endpoint is inferred from a related measure.
The load-bearing papers from a corpus of 9, each classified by what it does to the claim. Every DOI is taken from the corpus the claim was graded on.
Pivotal head-to-head RCT establishing PASI 75 superiority over apremilast at week 16.
“At week 16, response rates were significantly higher with deucravacitinib versus placebo or apremilast for PASI 75 (194 [58.4%] vs 21 [12.7%] vs 59 [35.1%]; P < .0001)”
Panel auditInternal validity: high · scope of inference: Moderate-to-severe plaque psoriasis patients over 16 weeks (POETYK PSO-1).Key limitations: abstract does not give the deucravacitinib-vs-apremilast contrast test separately from the pooled comparison · week 16 timepoint only for the primary contrast
Second pivotal RCT confirming statistically significant PASI 75 superiority vs apremilast.
“At week 16, significantly more deucravacitinib-treated patients versus placebo and apremilast achieved PASI 75 (53.0% vs 9.4% and 39.8%; P = .0004 vs apremilast)”
Panel auditInternal validity: high · scope of inference: Moderate-to-severe plaque psoriasis patients over 16 weeks, with maintenance to week 52 (POETYK PSO-2).Key limitations: margin over apremilast (53.0% vs 39.8%) is modest · week 16 primary contrast; later timepoints not compared to apremilast in the abstract
Regional subgroup concordant with pivotal trials; directionally supportive but not statistically powered.
“The proportion of Japanese patients achieving PASI 75 was numerically higher with deucravacitinib versus placebo and apremilast at Week 16 (78.1% vs. 11.8% and 23.5%, respectively) and versus apremilast at Week 24 (78.1% vs. 29.4%)”
Panel auditInternal validity: medium · scope of inference: Japanese moderate-to-severe plaque psoriasis patients (POETYK PSO-1 subgroup).Key limitations: subgroup, small n likely · difference described as numerical only, no p value · no sample sizes reported
The abstract reports only deucravacitinib response maintenance over time, with no apremilast comparison for PASI 75.
Panel auditInternal validity: medium · scope of inference: Durability of deucravacitinib PASI response from Week 16 to Week 52 in POETYK PSO-1/PSO-2.Key limitations: no apremilast comparison · maintenance endpoint, not head-to-head · no sample sizes reported
4 of 9 papers shown. The full review lists all of them, with the panel’s arbitration →
Claims are graded at each quarterly release, and re-graded between releases only when a pivotal trial lands. Every change is a new version of the claim.
Two direct double-blind phase 3 RCTs establish statistically significant PASI 75 superiority, tempered only by all confirmatory data arising from a single sponsor program.
Release 2026-q4 re-graded every claim from its corpus under protocol v0.19. An earlier release's grade is shown for the record; it came from an earlier protocol and is not a movement.
Assumptions that carry weight but are not themselves established.
The panel records the gap that would most move the claim, and the study that would close it.
Independent head-to-head replication. All confirmatory PASI 75 evidence sits within one sponsor's POETYK program ([1],[2],[4],[7],[8]), so the comparison has no external check. The panel rates this the highest-importance open gap for the claim, and names the study design that would close it: An investigator-initiated or independently funded randomized double-blind trial comparing deucravacitinib and apremilast on week-16 PASI 75 in moderate-to-severe plaque psoriasis.
Open question: Does the PASI 75 superiority of deucravacitinib over apremilast replicate outside the sponsor's POETYK program? Why it is still open: Every confirmatory head-to-head data point in the corpus comes from the POETYK program ([1],[2],[4],[7],[8]) with no independent trial.
Priors is a sceptical first reader, not peer review, and not medical advice.
Release 2026-q4 · graded 18 Sep 2026 · protocol v0.19