The Hassle Stops Here: Icotrokinra Takes Aim at Psoriasis Care Gaps

Jennifer Soung, MD, has spent nearly 2 decades researching psoriasis, and she doesn't mince words about what makes icotrokinra (Icotyde; Johnson & Johnson) different: efficacy close to a biologic, similar safety, and the simplicity of a once-daily pill. In a recent Dermatology Times interview, Soung — a board-certified dermatologist and clinical researcher at Southern California Dermatology in Santa Ana and clinical faculty at the University of California, Los Angeles — joined Adam Friedman, MD, FAAD, professor and chair of dermatology at George Washington School of Medicine and Health Sciences, to discuss what icotrokinra, a first-in-class oral IL-23 receptor antagonist, means for patients with moderate to severe plaque psoriasis and the clinicians who have long struggled to get them on systemic therapy.

A New Standard for Oral Therapy

Both experts agreed that icotrokinra marks a genuine departure from prior oral systemics. Agents such as methotrexate, cyclosporine, apremilast, and deucravacitinib have historically occupied a middle ground between topicals and biologics. Icotrokinra, in contrast, appears to close that gap considerably. As Friedman put it, "for the first time, we have an oral that is pretty much on par with the systemic" — a distinction he was careful to qualify pending head-to-head trial data, but one that meaningfully changes the shared decision-making conversation. Clinicians can now present patients with oral and injectable options as "somewhat analogous," rather than steering injection-averse patients toward a less effective alternative.

Mechanistically, the drug's novelty extends beyond its target. Unlike existing biologics that neutralize cytokines, icotrokinra blocks the IL-23 receptor directly. Its oral bioavailability is enabled by a macrocyclic peptide structure in which each amino acid is chemically modified, resisting protease degradation in the GI tract — a design both physicians described as a significant pharmaceutical innovation. Soung explained that "because of its unique macrocyclic structure," the drug resists the enzymatic breakdown that would ordinarily prevent peptide delivery via the oral route, with potential applications across multiple disease areas.

Practical Considerations and Remaining Questions

Friedman highlighted approval for patients aged 12 and older as particularly significant, noting that adolescents have historically had fewer systemic options and are often averse to injections. Both physicians also welcomed the elimination of mandatory tuberculosis screening, identifying it as a long-standing barrier to initiating therapy. Soung cited sobering real-world data: "Statistics show that only about 15, maybe up to 20% of patients with moderate to severe plaque psoriasis get a systemic treatment — that's mind-boggling to me, because we have so many great systemic treatments."

One area warranting further clinical guidance is the drug's fasting requirement. Friedman flagged early adherence as a potential challenge, recommending individualized counseling: "If we can get them past the 2-week mark, I think we can get them on board with better adherence."

The Takeaway for Clinicians

Icotrokinra offers dermatologists a meaningful new option in the shared decision-making conversation — an oral therapy that no longer requires patients to compromise on efficacy. With once-daily dosing, a favorable safety profile, reduced monitoring burden, and approval extending into the adolescent population, it holds genuine potential to expand systemic treatment to the substantial proportion of patients who remain undertreated.