Oral IL-23 Blocker Icotrokinra Brings Biologic-Like Efficacy to Psoriasis

Jennifer Soung, MD, a board-certified dermatologist and clinical researcher at Southern California Dermatology and clinical faculty at Harbor-UCLA, highlighted several developments shaping psoriasis care this year. Her comments centered on the oral IL-23 receptor antagonist icotrokinra (Icotyde), expanding pediatric treatment options, emerging oral TYK2 inhibitors, and data evaluating GLP-1 therapy alongside biologic treatment.

Across these developments, Soung emphasized the importance of approaching psoriasis as a systemic disease and considering patients' broader health alongside skin clearance.

Icotrokinra Brings Biologic-Like Efficacy to an Oral Pill

Song described icotrokinra as an important addition to the psoriasis treatment toolbox. The targeted oral peptide blocks the IL-23 receptor and is approved for adults and adolescents aged 12 years and older with moderate to severe plaque psoriasis who meet treatment eligibility requirements.

In her practice, Soung said she typically encourages biologic therapy for patients who are comfortable with injections because of the balance between efficacy and safety offered by current biologics. Icotrokinra, however, provides a high-efficacy oral option for patients who may be hesitant to begin injectable therapy.

“I have not seen an oral drug with safety showing placebo rates similar to active drug, and it's amazing,” Soung said.

She said the option may be particularly meaningful for patients who want substantial skin clearance but have concerns about injectable medications or their potential effects on the immune system.

Icotrokinra Offers a Favorable Safety and Monitoring Profile

Soung also highlighted icotrokinra's safety profile and limited laboratory monitoring burden. She noted that clinical trial data did not demonstrate an increased risk of upper respiratory tract infections and discussed the limited testing associated with treatment initiation.

Even with that profile, Soung said she continues to ask patients about routine primary care and may order screening laboratory tests when appropriate. Her goal is not solely to assess treatment eligibility, but to identify common comorbidities associated with psoriatic disease.

“I want to know if they have diabetes or high cholesterol,” Song said. “I really believe in an integrative approach to treating our patients with psoriatic disease.”

Pediatric Approvals Expand Treatment Access

Song also pointed to expanding treatment options for pediatric patients with plaque psoriasis as a significant development.

Teenagers just want to be normal and not noticed — Jennifer Soung, MD

She highlighted recent pediatric indications for systemic therapies including guselkumab (Tremfya) and risankizumab (Skyrizi), as well as topical roflumilast 0.3% cream (Zoryve), giving clinicians additional options for younger patients.

For Song, effectively treating psoriasis early can have effects extending beyond physical symptoms, particularly for children and adolescents navigating the social and emotional effects of visible disease.

“Teenagers just want to be normal and not noticed,” Soung said.

She described effective treatment at a young age as an opportunity to potentially change a patient's life trajectory by helping them achieve clearer skin.

Next-Generation Oral TYK2 Inhibitors on the Horizon

Soung also highlighted 2 investigational oral TYK2 inhibitors, zasocitinib and envudeucitinib, as therapies to watch.

Data for both agents were presented at the 2026 American Academy of Dermatology Annual Meeting, with Song describing the efficacy findings as encouraging and the safety profiles to date as favorable.

She said dermatologists will be watching how the FDA ultimately interprets the available safety data, particularly regarding potential laboratory monitoring requirements.

GLP-1 Combination Therapy Adds Benefit in Psoriatic Disease

Another development that caught Soung's attention was research evaluating GLP-1 therapy alongside biologic treatment in patients with psoriatic disease.

She discussed studies evaluating the addition of GLP-1 therapy to ixekizumab (Taltz) in patients with moderate to severe plaque psoriasis and psoriatic arthritis. According to Soung, patients with obesity who received GLP-1 therapy in addition to ixekizumab experienced greater improvements than those receiving ixekizumab alone. The studies also incorporated lifestyle and nutrition counseling.

“It really confirms the systemic nature of psoriatic inflammation,” Song said.

She noted that the benefits may extend beyond weight loss, with the possibility that GLP-1 therapies also influence inflammatory pathways. That possibility is particularly relevant because many patients with psoriatic disease also have metabolic and cardiovascular comorbidities.

“There's no doubt GLPs are transforming the management of chronic disease, not just in dermatology but in all areas of medicine,” Soung said.

That systemic perspective has also shaped Soung's conversations with patients. In addition to asking about primary care visits and medication changes, she routinely asks whether patients have developed new joint pain or stiffness.

Soung said she explains that these questions help determine whether inflammation associated with psoriasis may extend beyond the skin. Providing that context, she added, can help patients better understand that psoriatic disease is not necessarily limited to visible plaques.