The Dawn of Oral Peptides: Linda Stein Gold, MD, FAAD, on the FDA Approval of Icotrokinra

In this exclusive interview with Dermatology Times, Linda Stein Gold, MD, FAAD, director of dermatology clinical research at Henry Ford Health System in Detroit, Michigan, expressed excitement for the recent FDA approval of icotrokinra, an oral peptide therapy for patients aged 12 years and older with moderate to severe plaque psoriasis. As an oral, once-daily agent with favorable efficacy, tolerability, and safety, she reaffirmed that icotrokinra is a meaningful addition to the therapeutic landscape, particularly for patients who are candidates for systemic therapy but may prefer an alternative to injectable biologics.

Stein Gold emphasized that this approval is especially significant given the relative lack of innovation in oral psoriasis therapies compared with the rapid expansion of biologic agents. She notes that icotrokinra demonstrates efficacy approaching that of biologics while maintaining a strong safety profile, which may increase clinician and patient confidence in its use. Its oral formulation and simple dosing schedule may be particularly advantageous for adolescent patients, a population often underserved in systemic treatment strategies.

A key theme of the discussion is the need to overcome “treatment inertia” in dermatology. Stein Gold highlighted that many patients who meet criteria for systemic therapy—such as those with ≥10% body surface area involvement, disease affecting high-impact areas, or repeated failure of topical treatments—remain undertreated due to prolonged reliance on topical regimens. She advocates for earlier and more appropriate escalation to systemic therapies, underscoring that psoriasis is a systemic inflammatory disease requiring comprehensive management.

“Let's make sure that we advance the systemic therapy as appropriate,” she said. “We tend to cycle patients on topical therapy, and we really have to take a step back and make sure we're doing the best for our patients that we can.”

For icotrokinra to become a widely adopted first-line systemic option, Stein Gold stressed the importance of clinician familiarity with clinical trial data, particularly regarding its safety and efficacy in adolescent populations. She encourages dermatologists to critically evaluate emerging evidence and integrate new therapies into practice based on patient-specific needs.

Looking ahead, Stein Gold also highlighted her upcoming presentations at this week’s American Academy of Dermatology Annual Meeting in Denver, Colorado, where she will share long-term data on icotrokinra, including outcomes following treatment transitions, as well as new research on biologic therapies for atopic dermatitis.