AAD 2026: Inside the Development of Icotrokinra, Psoriasis's First Oral IL-23 Receptor Antagonist

The approval of icotrokinra (Icotyde; Johnson & Johnson) marks a meaningful shift in how dermatologists can approach systemic therapy for plaque psoriasis, offering an oral option that targets the IL-23 pathway with a mechanism distinct from existing biologics. Liza O'Dowd, MD, a physician at J&J whose work centers on developing medicines for dermatology conditions, spoke with Dermatology Times at the 2026 American Academy of Dermatology Annual Meeting about the drug's development journey^1,2 and what clinicians can expect in practice.

O'Dowd was involved with the program from its earliest stages, when the foundational question was whether a peptide could be made orally bioavailable and reach systemic levels sufficient to drive efficacy. "The idea that you can take a peptide and make it orally bioavailable and get it in through the gut, whose job is to basically eat peptides for lunch, and then get to those systemic levels that is needed to drive efficacy — that was like, it was a dream, but was it possible?" she told Dermatology Times. It took several iterations to land on the right molecule.

From Early Data to the ICONIC Program

The development path included the FRONTIER studies, which provided early proof of concept, followed by the four-study ICONIC program, which O'Dowd described as particularly notable for several reasons. The program included head-to-head data, enrolled adolescents — something she noted had not been done before in this context — and captured outcomes in difficult-to-treat areas, demonstrating total skin clearance benefit there as well.

"Watching that journey, setting those high bars of aspirations, and then actually achieving each of those goals" was meaningful to observe, she said. O'Dowd acknowledged that she has worked on many drugs over the course of her career, but called this one "really special just to watch it come to development."

What Dermatologists Should Know

For clinicians already familiar with IL-23 pathway blockade through existing injectable therapies, O'Dowd said the transition to thinking about icotrokinra should be relatively intuitive. The drug precisely targets the IL-23 receptor, which is expressed in the skin, and modulates the same pathway dermatologists know well. Where it differs is in its oral delivery and the practical simplicity that comes with it.

She framed the drug as a strong option for patients not responding adequately to topicals who need to step up to a systemic therapy. Access programs are in place to support patients in getting the medication, she said, and the clinical routine is straightforward. "You wake up, you take the pill, and then you should start seeing the benefit over time as our data bear out," O'Dowd told Dermatology Times.

She also highlighted the absence of pre-screening requirements and the lack of monitoring obligations once a patient starts the drug as practical advantages. "I think physicians will find it quite easy to use," she said, citing the combination of efficacy, safety, and oral convenience as the drug's defining profile.

Additional 2026 AAD Annual Meeting coverage can be found here.

Reference

1. ICOTYDE™ (icotrokinra) one-year results confirm lasting skin clearance and favorable safety profile in once‑daily pill for plaque psoriasis. News release. Johnson & Johnson. March 28, 2026. Accessed March 29, 2026. https://www.investor.jnj.com/investor-news/news-details/2026/ICOTYDE-icotrokinra-one-year-results-confirm-lasting-skin-clearance-and-favorable-safety-profile-in-oncedaily-pill-for-plaque-psoriasis/default.aspx

2. Hebebrand M. FDA Approves Icotrokinra, First Oral IL-23 Receptor Blocker for Psoriasis. Dermatology Times. March 18, 2026. Accessed April 1, 2026. https://www.dermatologytimes.com/view/fda-approves-ictrokinra-first-oral-il-23-receptor-blocker-for-psoriasis