1 Recommendations

1.1 Deucravacitinib is recommended as an option for treating moderate to severe plaque psoriasis in adults, only if:

the Psoriasis Area and Severity Index (PASI) score is 10 or more and the Dermatology Life Quality Index (DLQI) score is more than 10
the condition has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated
the company provides deucravacitinib according to the commercial arrangement.

1.2 Consider stopping deucravacitinib between 16 weeks and 24 weeks if there has not been at least a 50% reduction in the PASI score (PASI 50) from when treatment started.

1.3 Consider stopping deucravacitinib at 24 weeks if the psoriasis has not responded adequately. An adequate response is defined as:

a 75% reduction in the PASI score (PASI 75) from when treatment started or
a 50% reduction in the PASI score (PASI 50) and a 5-point reduction in DLQI from when treatment started.

1.4 If people with the condition and their clinicians consider deucravacitinib to be 1 of a range of suitable treatments (see section 3.18), after discussing the advantages and disadvantages of all the options, use the least expensive. Take account of administration costs, dosage, price per dose and commercial arrangements.

1.5 Take into account how skin colour could affect the PASI score and make any adjustments needed.

1.6 Take into account any physical, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI and make any adjustments needed.

1.7 These recommendations are not intended to affect treatment with deucravacitinib that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Treatment for moderate to severe plaque psoriasis that has not responded to conventional systemic non-biological treatments or phototherapy includes apremilast, dimethyl fumarate and systemic biological treatments. Deucravacitinib is an alternative to apremilast, dimethyl fumarate and systemic biological treatments.

Clinical trial evidence shows that deucravacitinib improves symptoms of plaque psoriasis compared with placebo and apremilast. Deucravacitinib was indirectly compared with apremilast, dimethyl fumarate and several systemic biological treatments. The indirect comparison suggests it improves symptoms better than apremilast and dimethyl fumarate, and works as well as some biological treatments but not as well as others.

The cost-effectiveness estimates for deucravacitinib compared with apremilast, dimethyl fumarate and most biological treatments are within the range that NICE normally considers an acceptable use of NHS resources. So, deucravacitinib is recommended.