The latest findings from the ICONIC-ADVANCE 1 and 2 trials reveal significant advancements in psoriasis treatment options, specifically comparing the investigational drug icotrokinra (ICO) to deucravacitinib. Despite the growing range of therapies available, many patients report dissatisfaction with current treatments. This discussion, led by Linda Stein Gold, MD, and her colleagues, highlights critical gaps in psoriasis care and the crucial need for more effective solutions.
The series opens by examining the insights gathered from the ENCOMPASS and Stein Gold 2025 surveys, which indicate a strong preference among patients for oral therapies over injectable options. Many patients express ongoing dissatisfaction with their current treatment plans, underscoring the necessity for healthcare providers to integrate patient lifestyles, comorbidities, and psychosocial factors into shared decision-making processes.
Dr. Stein Gold and her team delve into the implications of the International Psoriasis Council’s (IPC) new definition of “topical failure.” They discuss how this new framework could help reduce what is termed “topical churn,” thereby allowing for a quicker transition to systemic therapies when necessary. This proactive approach may enhance patient outcomes by addressing the limitations of topical treatments earlier in the disease course.
Clinical Development of Icotrokinra
The panel provides a comprehensive overview of the icotrokinra clinical development program, focusing on the ICONIC-ADVANCE 1 and 2 trials. Results from these trials demonstrate superior efficacy of ICO compared to deucravacitinib at both 16 and 24 weeks, with a favorable safety profile. The discussion also includes new data from the ICONIC-LEAD trial at week 52, which shows sustained clearance and no new safety signals for both adults and adolescents.
The implications of these findings extend to the management of adolescent psoriasis. The panel reflects on how early and aggressive oral treatments, such as ICO, could potentially prevent the progression to psoriatic arthritis (PsA), marking a pivotal moment in the evolution of oral IL-23–targeted therapies.
Managing Active Psoriatic Arthritis
Shifting focus, the discussion turns to managing active psoriatic arthritis. Recent findings from the APEX phase 3b study reveal that guselkumab offers the first clear evidence of IL-23–mediated inhibition of structural joint damage. This reinforces the rationale for initiating biologic treatments in high-risk patients at an early stage.
The experts compare the APEX study results to previous IL-23 trials, examining the implications for therapy sequencing. They highlight additional emerging data presented at the Fall Clinical 2025 conference, including insights from the SPECTREM and PSOLAR studies, which further inform treatment strategies.
In concluding remarks, Dr. Stein Gold and her colleagues advocate for a forward-thinking approach in psoriasis care. They emphasize the importance of personalized therapy selection, early detection of psoriatic arthritis, and collaborative efforts across specialties to elevate the standard of care for patients suffering from this complex condition.
This comprehensive exploration of the current therapeutic landscape not only sheds light on the emerging treatments available but also underscores the need for continued innovation and patient-centered care in the management of psoriasis and psoriatic arthritis.
