The Consumer’s Guide to JAK Inhibitors for Psoriasis

The FDA approved deucravacitinib (Sotyktu) in September 2022 to treat moderate to severe psoriasis. It is a type of JAK inhibitor known as a TYK2 inhibitor.

But more may be coming down the pike.

While JAK inhibitors, as a drug class, are new to psoriasis, they have been used to treat autoimmune diseases for over a decade. The first JAK inhibitor was approved as a treatment for rheumatoid arthritis in 2012, and many more have been approved to treat other conditions since.

Around 30 percent of people with psoriasis also have psoriatic arthritis, which causes inflammation, swelling, and pain in the joints. Two other JAK inhibitors — tofacitinib (Xeljanz) and upadacitinib (Rinvoq) — are approved to treat psoriatic arthritis.

Although they’re not approved to treat psoriasis, “If you’re given [one of these drugs] for psoriatic arthritis, it almost certainly is going to make your skin better, too,” notes Steven R. Feldman, MD, PhD, a professor of dermatology at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Likewise, “If you’re given [deucravacitinib] for psoriasis, it’s very likely going to make your arthritis better,” even though this new drug is not specifically indicated for treating psoriatic arthritis.

This JAK inhibitor is taken once per day. By contrast, the only other oral treatment for plaque psoriasis, a disease-modifying drug known as apremilast (Otezla), must be taken twice a day and at a higher dose.

Note, too, that biologics, another systemic psoriasis treatment, have to be injected or taken as an infusion.

Two trials (called POETYK PSO-1 and PEOTYK PSO-2) found that 6 milligrams (mg) of deucravacitinib once a day was more effective than 30 mg of apremilast twice daily. After taking the JAK inhibitor for 24 weeks, 7 out of 10 people achieved at least a 75 percent improvement in their psoriasis severity and surface area affected, notes Dr. Sobell, and maintained those results after a year of continuing to take the drug.

Similarly, other research has shown that another JAK inhibitor, tofacitinib (Xeljanz), is effective for treating both psoriasis and psoriatic arthritis, even though it’s approved only for the latter.

A two-year study that focused on the safety and effectiveness of deucravacitinib found the most common risks associated with it to be mild to moderate, such as upper respiratory infection or headache.

This is different from the JAK inhibitors that are approved as treatments for psoriatic arthritis. Both tofacitinib and upadacitinib come with a black box warning about an increased risk of cancer and serious heart-related problems, such as blood clots, heart attack, and stroke, for some people.

Because deucravacitinib works differently from these other JAK inhibitors, it poses fewer risks and doesn’t carry this black box warning, notes Saakshi Khattri, MD, a board-certified dermatologist and rheumatologist and an assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai Hospital in New York City.

That said, some people who take deucravacitinib may experience a serious allergic reaction. The drug can impact your immune system, making you more susceptible to respiratory infections. It may also increase your risk of certain types of cancer, such as lymphoma, and can lead to serious muscle damage, known as rhabdomyolysis.

This psoriasis medication can be costly — over $6,000 a month.

But if you and your doctor decide that trying a JAK inhibitor for psoriasis may be right for you, your insurance company should cover most of the cost. Even then, you may have some out-of-pocket expenses based on the details of your prescription benefits. In that case, you can reach out to the drug manufacturer directly to see if you qualify for their patient assistance programs, which help cover your out-of-pocket drug costs.