Choosing the Right Plaque Psoriasis Patient for Icotrokinra

In ‘Choosing the Right Plaque Psoriasis Patient for Icotrokinra,’ our panel explores real-world case selection.

Andrew Mastro, MS, PA-C, asks Alexa Hetzel, MS, PA-C, to describe the patient profile she has in mind when reaching for icotrokinra. Hetzel says she is cautious about heavy joint involvement given the limited joint-specific data available so far, but describes strong outcomes in patients who were stuck on topical therapy, wanted an oral option, and had not found existing orals compelling enough to switch. She recounts steering a patient with severe scalp psoriasis away from greasy topical regimens and toward icotrokinra, citing the trajectory she now expects to share with patients: over 40% improvement by four weeks, 87% improvement by week 16, and close to 90% by week 24.

Hetzel then shares a case of a patient who had been treated for atopic dermatitis with an injectable biologic but told Hetzel she no longer wanted an injection. A biopsy confirmed classic psoriasis rather than atopic dermatitis, and Hetzel offered icotrokinra as a once-daily alternative. The patient returned a month later with only residual redness from the biopsy site itself, emotional at having her skin, and her summer, back after a period of misdiagnosis. Mastro notes the confidence required to stand behind that kind of recommendation with a patient who had already been through an unsuccessful treatment course.

The conversation then flips to the opposite question: which patients still warrant a biologic or a different oral agent. Hetzel says patients already doing well on deucravacitinib or apremilast have no reason to switch, and that insurance coverage for deucravacitinib has become inconsistent in her New Jersey market, which factors into new-start decisions. She leans toward a biologic for patients with significant joint involvement or a personal or family history of inflammatory bowel disease, often coordinating with a gastroenterology colleague, and for patients who simply want the lowest-effort regimen, since an infrequent injectable visit can be easier for some patients to manage than a daily pill.

In the next episode, ‘Positioning Icotrokinra as First-Line Therapy for Plaque Psoriasis,’ the panelists make the case for icotrokinra as a true first-line option and share their top practice-changing takeaways.