A Psoriasis Drug's Cardiovascular Case Rests on Borrowed Evidence

A new post hoc analysis in the September 2026 issue of the Journal of Investigative Dermatology looks at what deucravacitinib does to the neutrophil-to-lymphocyte ratio and other blood markers tied to cardiovascular risk in psoriasis patients. The paper, led by Yi Luo with senior author Nehal N. Mehta, draws on data already collected in the phase 3 POETYK PSO-1 and PSO-2 trials rather than a new prospective study, which sets the boundaries on what it can actually claim.

That distinction matters because of what a post hoc biomarker analysis is built to do and what it isn't. The original trials were designed and powered to measure psoriasis skin clearance, not cardiovascular outcomes. Pulling NLR values out of that dataset after the fact can show an association between drug exposure and a lower ratio, but it cannot establish that the drug prevents a heart attack or stroke. The paper's scope is a biomarker signal, not a clinical outcome.

Mehta's own prior work is the reason NLR is being tracked here at all. His group previously linked a drop in NLR after a year of biologic therapy, roughly 14.5 percent, to a reduction in non-calcified coronary plaque burden measured by CT angiography in psoriasis patients. That correlation, published through his lab's coronary-imaging research, is the closest thing this field has to evidence that NLR reflects something happening in the arteries rather than just in a blood draw. It was generated using biologics, not a TYK2 inhibitor, so applying it to deucravacitinib is an extrapolation the new paper doesn't independently test.

Deucravacitinib carries a specific backstory that makes a cardiovascular biomarker paper useful to publish now. It is a TYK2 inhibitor, a narrower and more selective mechanism than the JAK inhibitors that picked up boxed warnings for cardiovascular and clotting risk after the 2021 ORAL Surveillance trial results on tofacitinib. When the FDA approved deucravacitinib in September 2022, it did not require that same boxed warning, and safety data pooled across the POETYK program at one and four years has shown low, stable rates of major cardiovascular events, around 0.3 per 100 person-years. A post hoc paper adding a favorable biomarker story on top of that safety record fits a pattern already seen with other psoriasis drugs, including similar NLR and platelet-to-lymphocyte ratio analyses published for guselkumab and secukinumab.

The guselkumab version of this exercise, a 2025 analysis in Dermatology by Kearney and colleagues pooling the VOYAGE I, VOYAGE II, and ECLIPSE trials, found that adalimumab actually produced a larger drop in NLR and related ratios than guselkumab did, while secukinumab performed comparably to guselkumab in its own 2022 pooled analysis. Those results are a reminder that a bigger biomarker shift doesn't sort neatly by how new or targeted a drug's mechanism is. Readers should look for whether the deucravacitinib paper reports how its numbers compare to a placebo or apremilast arm, since POETYK included both, because a comparison against an active or inactive control is what would let the biomarker finding carry any weight at all.

None of this is disclosed as fraudulent or hidden. It's the ordinary mechanics of how a drug's cardiovascular reputation gets built in stages: a trial not designed for the question, a biomarker borrowed from a different drug class's imaging study, and a publication timed to a moment when the manufacturer is expanding indications and defending market share against injectable competitors. Sotyktu brought in about $291 million globally in 2025 and picked up FDA approval for psoriatic arthritis this past March, with EU approval following in May. What the paper actually settles is narrower than what its publication timing might suggest: a lab value moved in trial data already years old, evaluated against a surrogate relationship built in a different patient population on different drugs.