The recent Peer Exchange has highlighted significant advancements in psoriasis treatment through findings from the ICONIC-ADVANCE 1 and 2 trials. These studies focus on the investigational drug icotrokinra (ICO), which has demonstrated superior efficacy compared to deucravacitinib over 16 and 24 weeks. The results indicate not only enhanced treatment options but also a shift in the approach to managing psoriasis, aiming to address persistent dissatisfaction among patients.
In the initial segment of the discussion, Linda Stein Gold, MD, and her colleagues examined data from the ENCOMPASS and Stein Gold 2025 surveys. The findings reveal ongoing dissatisfaction among psoriasis patients regarding current therapies. Notably, there is a strong preference for oral agents over injectable treatments. Factors such as lifestyle, comorbidities, and psychosocial burdens significantly influence both shared decision-making and treatment adherence.
The panel also delves into the International Psoriasis Council’s new definition of “topical failure.” This definition is crucial as it seeks to reduce “topical churn” and encourage the adoption of systemic therapies earlier in the disease progression. By understanding these dynamics, healthcare providers can better tailor treatments to individual patient needs and preferences, ultimately improving satisfaction and outcomes.
Exploring the Efficacy of icotrokinra
A substantial portion of the discussion focused on the clinical development program for icotrokinra, particularly the results from the ICONIC-ADVANCE trials. These trials have shown that ICO not only outperforms deucravacitinib in terms of efficacy but also maintains a favorable safety profile. New data from the ICONIC-LEAD study, released during the exchange, highlighted sustained clearance at week 52 without new safety concerns for both adults and adolescents.
The implications of these findings for treating adolescent psoriasis are significant. Early and aggressive intervention with oral therapies like ICO may be critical in preventing the progression to psoriatic arthritis (PsA), marking a pivotal development in the realm of oral IL-23–targeted therapies. Stein Gold and her colleagues emphasized the importance of proactive treatment strategies to mitigate long-term complications associated with the disease.
Advancements in Psoriatic Arthritis Management
The conversation then shifted to the management of active psoriatic arthritis, with new insights from the APEX phase 3b study. This research demonstrated that guselkumab offers the first clear evidence of IL-23–mediated inhibition of structural joint damage. This reinforces the rationale for early biologic therapy in high-risk patients, aiming to enhance patient outcomes and quality of life.
The panel compared APEX findings with previous IL-23 studies, discussing therapy sequencing and the potential for integrated treatment approaches. Emerging data from the Fall Clinical 2025, including results from the SPECTREM and PSOLAR studies, further supports the need for early intervention and personalized therapy selection.
In conclusion, Stein Gold and her colleagues advocated for a comprehensive approach to psoriasis care, focusing on early detection of PsA and fostering collaboration across specialties. By integrating personalized therapy and prioritizing patient preferences, healthcare providers can significantly elevate the standards of care for patients living with psoriasis and its associated comorbidities.
