Exploring the Efficacy and Durability of Oral Agents in Psoriasis

In ‘Exploring the Efficacy and Durability of Oral Agents in Psoriasis,’ our panel explores how these oral agents compare.

Andrew Mastro, MS, PA-C, asks Alexa Hetzel, MS, PA-C, to place icotrokinra alongside the oral agents clinicians have relied on to date, apremilast and deucravacitinib. Hetzel cautions that no head-to-head trial links all three directly, since each agent was studied against a different comparator. Icotrokinra was compared with deucravacitinib, and deucravacitinib was compared with apremilast, so any three-way ranking has to be inferred. Within that structure, she notes that icotrokinra demonstrated statistically significant superiority over deucravacitinib across every efficacy endpoint studied, including IGA 0/1 response and the harder-to-reach PASI 100 bar, while deucravacitinib had previously shown superiority over apremilast.

The safety comparison is where Hetzel sees the clearest separation. Icotrokinra's placebo-like safety profile leaves little for patients to research or worry about, in contrast with the gastrointestinal upset associated with apremilast and the broader downstream inhibition concerns tied to deucravacitinib's mechanism. She frames a favorable safety profile as reassurance for both clinician and patient, since it removes one more variable from an already complex treatment decision.

Mastro then turns to durability, noting that icotrokinra data extends to 52 weeks with high rates of clear or almost-clear skin maintained through one year, including in high-impact sites. Hetzel responds that durability matters because plaque psoriasis is a lifelong disease that cannot be cured, only managed, so a therapy patients can stay on long term reduces the need for future switching. She points to data showing that patients who started on deucravacitinib and transitioned to icotrokinra after 24 weeks continued to respond, reinforcing that sequencing through icotrokinra remains an option even after another oral agent. Hetzel also describes a patient in her own clinical research practice who reached the two-year mark in a study and remains clear, illustrating durability that extends beyond the formal 52-week dataset and giving patients meaningful peace of mind about staying on a therapy that continues to work.

In the next episode, ‘Treating Adolescent Plaque Psoriasis: Tolerability and Adherence,’ Mastro and Hetzel turn to the adolescent population and how tolerability and once-daily dosing shape that conversation.