QWhen, if ever, do you check CPK levels on patients on deucravacitinib?

Sotyktu (Deucravacitinib), an oral selective allosteric TYK2 inhibitor, is approved for the treatment of moderate to severe plaque psoriasis in adults. It specifically targets the TYK2 protein within the JAK-STAT signaling pathway, which is essential for mediating the actions of key cytokines such as IL-12, IL-23, and type I interferons. Unlike broader JAK inhibitors, TYK2 inhibition results in a more focused effect on immune regulation without significantly affecting pathways associated with lipid metabolism or hematopoiesis. Clinical trials, including the POETYK PSO-1 and PSO-2 studies, demonstrated that Sotyktu has a favorable safety profile, with adverse events generally limited to mild infections, transient liver enzyme elevations, and isolated increases in creatine phosphokinase (CPK). The package insert does not mandate routine laboratory monitoring during treatment, although baseline evaluations of hepatic function, renal function, and hematologic parameters may be considered for patients with comorbidities. Periodic monitoring is recommended only for patients who develop clinical symptoms suggestive of liver dysfunction, myopathy, or infection. Unlike JAK1 and JAK2 inhibitors, deucravacitinib does not significantly elevate lipid parameters, and routine lipid monitoring is unnecessary. These recommendations are supported by pivotal clinical trial data and post-marketing safety analyses (NEJM, JAMA Dermatology, JAAD).

In my clinic, as long as patients have yearly blood work done by their primary care provider and are not showing any clinical concerns for liver dysfunction or myopathy, I do not routinely check CPK levels. If signs and symptoms arise, or if patients have liver comorbidities, I check baseline liver enzymes and CPK and repeat anywhere from a month later to every 6 months depending on the case.

Based on current evidence, Sotyktu’s safety profile does not necessitate routine lab monitoring. However, dermatologists should individualize monitoring strategies based on the patient’s comorbidities, concurrent medications, and any signs of adverse effects during treatment.

References

1. Strober B, Thaçi D, Sofen H, et al. Deucravacitinib for moderate to severe plaque psoriasis: Results from the POETYK PSO-1 and PSO-2 trials. N Engl J Med. 2022;387(12):1148-1158.
2. Armstrong AW, Gooderham M, Warren RB, et al. Safety and efficacy of TYK2 inhibition with deucravacitinib in plaque psoriasis: A comprehensive review. J Am Acad Dermatol. 2023;88(3):589-598.
3. Lebwohl MG, Blauvelt A, Mallbris L, et al. The role of TYK2 inhibitors in immune-mediated diseases: Clinical evidence from deucravacitinib trials. JAMA Dermatol. 2023;159(4):383-392.