The new pill for psoriasis is Sotyktu (deucravacitinib), approved by the FDA in 2022 for adults with moderate-to-severe plaque psoriasis. It’s the first oral medication in a new drug class, working through a different biological pathway than older pills. For many people with psoriasis who want effective treatment without injections, it represents a meaningful step forward.
How Sotyktu Works
Sotyktu targets a specific protein called TYK2, which plays a key role in the immune signaling that drives psoriasis. Your immune system relies on a family of signaling proteins called JAK enzymes to pass messages between cells. TYK2 is one member of that family, and it’s heavily involved in the inflammatory pathways that cause skin cells to multiply too fast and form psoriatic plaques.
What makes Sotyktu different from older immune-targeting drugs is its precision. Rather than broadly dampening multiple JAK pathways (which can suppress the immune system more than necessary), it locks onto TYK2 alone. Research published in the Journal of Investigative Dermatology found that the drug blocks TYK2 in three distinct states, essentially shutting the protein down whether it’s active or inactive. It does this by binding to a regulatory region of the protein rather than the main active site, which is why it can be so selective. This selectivity is the reason Sotyktu doesn’t carry the same broad immune-suppression warnings that older JAK inhibitors do.
How Well It Works
In the phase 3 POETYK PSO-1 trial, 58.4% of patients taking Sotyktu achieved at least a 75% improvement in their psoriasis severity score (called PASI 75) by week 16. That compared to just 12.7% for placebo. The trial also tested Sotyktu head-to-head against the older oral psoriasis pill apremilast (Otezla), and Sotyktu came out clearly ahead: 58.4% versus 35.1% reaching that same benchmark. Similarly, about 54% of Sotyktu patients achieved near-clear or clear skin ratings, compared to 32% on apremilast.
Results continued to build over time. Among patients in both POETYK trials who switched from apremilast to Sotyktu partway through, more than 40% reached the 75% improvement mark by week 52, and roughly 18 to 30% achieved 90% clearance. For a once-daily pill, those numbers are notable, though they still fall short of the most potent injectable biologics.
How It Compares to Otezla
Before Sotyktu, the main oral option for moderate-to-severe plaque psoriasis was apremilast (Otezla), which works through a completely different mechanism. The POETYK trials were designed specifically to compare the two. Sotyktu outperformed apremilast on every efficacy measure at 16 weeks, clearing skin faster and more completely. For people who tried Otezla and didn’t get enough improvement, the trial data suggests Sotyktu can still deliver meaningful results after switching.
The side effect profiles also differ in ways that matter day to day. Apremilast is more likely to cause gastrointestinal problems like diarrhea and nausea, along with headaches. Sotyktu tends toward skin-related side effects instead: acne, folliculitis (inflamed hair follicles), itching, and rash. Some people also develop mouth sores. A pharmacovigilance study comparing real-world reports for both drugs confirmed this pattern. If stomach issues were a dealbreaker on Otezla, Sotyktu’s side effect profile may be easier to tolerate, though the trade-off is a higher chance of skin-related reactions.
What Taking It Looks Like
Sotyktu is a once-daily pill taken by mouth. It’s approved for adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or light therapy. That generally means people whose psoriasis covers enough of their body, or affects visible or sensitive areas enough, that topical creams alone aren’t cutting it.
Before starting, your doctor will likely screen for infections, since the drug does modulate part of the immune system. The screening process typically includes checking for tuberculosis. You’ll also need periodic monitoring while on the medication, though the specifics depend on your overall health picture.
Cost and Insurance Coverage
Like most newer specialty medications, Sotyktu carries a high list price. However, Bristol Myers Squibb (the manufacturer) offers a co-pay assistance program for commercially insured patients that can bring out-of-pocket costs down to as little as $0 per month. Eligibility depends on your insurance type. Patients on government insurance programs like Medicare or Medicaid typically don’t qualify for manufacturer co-pay cards, though other patient assistance options may exist. If you’re prescribed Sotyktu, it’s worth checking eligibility through the manufacturer’s website before filling the prescription.
What’s Coming Next in Oral Psoriasis Treatment
Sotyktu may not be the last major oral breakthrough. A drug called JNJ-77242113 is currently in clinical trials, and it works through yet another mechanism: blocking the receptor for interleukin-23, a key immune messenger in psoriasis. IL-23 blockers have been among the most effective injectable biologics for psoriasis, so an oral version could be significant. In a phase 2 trial published in the New England Journal of Medicine, the drug showed greater efficacy than placebo across multiple doses after 16 weeks. It’s still years from potential approval, but it signals that the options for people who prefer pills over injections are likely to keep expanding.