Deucravacitinib treatment in lichen planopilaris

In a small phase 2 study with patients with lichen planopilaris (LPP), deucravacitinib led to ameliorations in signs and symptoms. After 16 weeks, 80% of participants had a Physician Global Assessment (PGA) response.

“LPP is a chronic inflammatory condition, characterised by a lymphocyte-rich infiltration that causes scarring alopecia, often affecting the posterior occiput of the scalp,” Dr Aaron Mangold (Mayo Clinic, AZ, USA) explained [1]. Currently, effective or approved treatments for LPP are still lacking. As the upstream activation of Th17 lymphocytes by IL-23, IL12, and IFN 1 might be relevant in the pathogenesis, Dr Mangold and colleagues investigated deucravacitinib as a possible treatment option in a single-arm phase 2 study (NCT06091956). He presented the interim results of weeks 12 and 16 of this first clinical trial on a selective TYK2 inhibitor in LPP.

The 10 adult participants with biopsy-proven LPP received twice-daily 6 mg of deucravacitinib over 24 weeks, after a washout period for their prior medication. Besides safety, the assessment included measures such as LPP Activity Index (LPPAI), Dermatology Life Quality Index (DLQI), Physician Global Assessment (PGA), and pruritus numeric rating scale (NRS) every 4 weeks. The mean age of the study cohort was 61.4 years, 70% were women, and they had a mean disease duration of 6.4 years. Baseline mean LPPAI and DLQI were 3.8, and pruritus NRS 4.2.

At week 12, LPPAI decreased to 1.6 (P=0.006) and it further reduced to 1.2 at week 16 (P=0.008). No data on regrowth was provided. In terms of PGA, “we saw a 20% response rate by week 2 of greater than 50% improvement, by week 12 that significantly increased up to 80%, and by week 16, all participants had a greater than 50% response,” Dr Mangold revealed. He further underlined that in contrast to atopic dermatitis, clinical improvement in LPP was detected before itch improvement. “We see the average time to response of greater than 50% NRS reduction at about 11.1 weeks,” Dr Mangold specified.

The safety evaluation of deucravacitinib did not show any serious treatment-emergent adverse events. Among the 13 mild drug-related adverse events, acne was the most common (70%).

1. 
   
   1. Mangold A, et al. Deucravacitinib in the treatment of lichen planopilaris - interim analysis. D1T01.1E, EADV Congress 2024, 25–28 September, Amsterdam, the Netherlands.

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Posted on 6 November 20247 November 2024