The Cutaneous Connection: Diving Into the Safety and Efficacy of Icotrokinra, the New Oral IL-23 Peptide in Psoriasis

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In this episode of The Cutaneous Connection, Dermatology Times revisits an exclusive interview recorded at the 2026 American Academy of Dermatology (AAD) Annual Meeting with Liza O'Dowd, MD, vice president of immunodermatology and respiratory disease areas at Johnson & Johnson and co-developer of icotrokinra (Icotyde). Icotrokinra was approved on March 18, 2026, for the treatment of moderate to severe plaque psoriasis in adults and adolescents 12 years and older. Icotrokinra represents the first oral peptide agent in its class, a once-daily IL-23 receptor antagonist peptide designed to deliver biologic-level efficacy through a non-injectable route.

O'Dowd reviews 52-week data from the ICONIC clinical program, highlighting that approximately 50% of adult patients achieved total skin clearance (IGA 0) at one year. Notably, she discusses findings from the LEAD study, which enrolled adolescent patients—a population not previously included in comparable psoriasis trials—in which approximately 60% achieved total skin clearance at week 52. These longer-term results reinforce the sustained efficacy signal observed at earlier time points and expand the evidence base supporting icotrokinra's use across age groups.

The discussion also addresses the drug's emerging safety profile. Through 52 weeks, rates of adverse events were within 1.1% of placebo, with no new safety signals identified at longer follow-up intervals. O'Dowd highlights a clinically meaningful distinction in labeling: rather than mandating tuberculosis testing for all patients, icotrokinra's label calls for considered testing based on individual risk factors, a departure from standard requirements for other agents in the psoriasis space that reflects the drug's precise mechanism of action at the IL-23 receptor.

O'Dowd contextualizes icotrokinra's place in the treatment landscape, noting that investigators and community dermatologists are already envisioning its role as a first-line systemic option following topical therapy failure. She emphasizes the patient preference data driving this positioning: many patients with moderate to severe psoriasis would choose an oral agent over an injectable given equivalent efficacy and safety. With no required pre-treatment screening burden and no ongoing laboratory monitoring, icotrokinra offers a streamlined prescribing experience for clinicians.

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