Oral Therapy Evolution in Plaque Psoriasis: From PDE4 to Peptides

In this episode, ‘Oral Therapy Evolution in Plaque Psoriasis: From PDE4 to Peptides,’ the panelists, both practicing in dermatology, explore the evolving oral treatment landscape in plaque psoriasis.

Andrew Mastro, MS, PA-C, shifts the conversation to the evolution of oral therapy in plaque psoriasis, asking Alexa Hetzel, MS, PA-C, how the market has changed as oral options have matured. Hetzel describes a field that has moved well beyond injectables-only, starting with PDE4 inhibitors that gave patients ineligible for biologics, such as those with a malignancy history, a viable systemic option, even if skin clearance lagged behind joint response. TYK2 inhibitors followed and delivered strong results in hand and foot psoriasis, though Hetzel notes that provider unfamiliarity with JAK-adjacent safety messaging limited uptake.

Hetzel frames oral peptides like icotrokinra as the culmination of what clinicians have wanted from an oral agent: once-daily dosing, a formulation that can be dispersed in water, and efficacy that approaches what biologics deliver. Mastro agrees that biologic-like efficacy is a phrase that resonates with the clinicians he speaks with, and the two discuss how newer oral agents are resetting expectations for what an oral therapy can accomplish compared with injectable options.

The discussion turns practical when Mastro raises adherence, noting that oral regimens can be uniquely challenging to sustain despite their convenience. Hetzel points out that many patients are already managing daily oral medications for other conditions, from blood pressure to thyroid disease, and that a shelf-stable, room-temperature oral therapy fits easily into an existing routine. For patients who travel for extended periods, an oral option can also solve access problems that make injectable dosing difficult. She adds that missed doses are a normal part of any regimen, oral or injectable, and that patients who occasionally miss a dose are not going to lose the ground they have gained, an assurance borne out by published randomized-withdrawal data on icotrokinra showing that response holds up well on continuous therapy and erodes only gradually after full discontinuation. Ultimately, Hetzel says the decision comes down to matching the regimen to what a given patient will actually be able to execute consistently.

In the next episode, ‘Icotrokinra vs Deucravacitinib and Apremilast: Efficacy and Durability,’ the panelists weigh icotrokinra against deucravacitinib and apremilast on efficacy, safety, and durability of response.In the next episode, ‘Oral Therapy Evolution in Plaque Psoriasis: From PDE4 to Peptides,’ Mastro and Hetzel trace how oral therapy evolved from PDE4 and TYK2 inhibition to once-daily oral peptides, and how that shift is changing conversations about adherence.