Oral IL-23 receptor blockade kept about three in four patients clear or almost clear for a year

Design

Two phase 3, randomised, placebo- and active comparator-controlled trials with 52-week follow-up

Population

1,505 adults with moderate-to-severe plaque psoriasis

Primary outcome

IGA 0/1 and PASI 90 (week 16 primary; durability through week 52)

Effect

About 70–75% IGA 0/1 or PASI 90 from week 24 to 52; 85–90% of week-16 responders maintained response

Pooled one-year results from the ICONIC-ADVANCE 1 and 2 phase 3 trials, published in the British Journal of Dermatology on 18 September, follow 1,505 adults with moderate-to-severe plaque psoriasis randomised to icotrokinra 200 mg once daily, placebo or deucravacitinib, with placebo and deucravacitinib groups switching to icotrokinra at weeks 16 and 24.

The trials had already shown icotrokinra superior to placebo at week 16 and to deucravacitinib at weeks 16 and 24. Between weeks 24 and 52, about 70–75% of those randomised to icotrokinra were clear or almost clear (IGA 0/1 and PASI 90) and about half were completely clear. Of those clear or almost clear at week 16, around 85–90% still were at week 52. Patients who switched in from placebo or deucravacitinib reached similar response rates. No new safety signal emerged through 52 weeks.

Icotrokinra is a peptide taken by mouth that blocks the IL-23 receptor, so it brings the mechanism of the injectable IL-23 antibodies to a tablet. The comparison with deucravacitinib, another oral agent, ends at week 24; after that the data are uncontrolled. One year is short for a drug class that patients may take for decades. Its availability and approval status in India are unknown.

• For patients who will not inject, note that an oral IL-23 pathway option is in late-stage development.
• Expect most responses to build to week 24 and then hold; judge early non-response with that timeline in mind.
• Its comparison with deucravacitinib ran only to week 24; later data are open-label.
• Check local approval before discussing it as an option; status in India is unknown.

Why it matters

A tablet with IL-23 antibody-like clearance would remove the injection barrier for many patients.

Don't overread it

After week 24 there is no comparator, and one year of safety data cannot exclude rare or late harms.

The statistics, in plain English

The 85–90% maintenance figure applies to people who had already responded by week 16, so it describes durability, not the chance of responding. Uncontrolled continuation data can look better than controlled data because people who stop treatment drop out.

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