Psoriasis Awareness & Action Month: New Oral Drugs and Other Developments

Oral systemic therapy for plaque psoriasis has historically lagged injectable biologics in efficacy. The US Food and Drug Administration (FDA) approved icotrokinra (Icotyde), the first oral IL-23 receptor antagonist for moderate to severe plaque psoriasis, in March 2026. The ICONIC-LEAD trial found 65% of patients reached an Investigator's Global Assessment score of 0/1 and 50% achieved PASI 90 at week 16, versus 8% and 4% with placebo (P <.001).¹

"It's exciting times to be a psoriasis patient, to be a prescriber in the psoriasis space," said Saakshi Khattri, MD, associate professor and director of the Center for Connective Tissue Diseases at the Icahn School of Medicine at Mount Sinai.

Zasocitinib, an investigational TYK2 inhibitor, produced comparable clearance in its phase 3 LATITUDE trials.² Combination therapy targeting metabolic comorbidity also advanced in 2026. The phase 3b TOGETHER-PsA trial found ixekizumab plus tirzepatide produced greater joint disease control than ixekizumab monotherapy in patients with psoriatic arthritis (PsA) and obesity or overweight. Of combination-therapy patients, 31.7% reached ACR50 response plus at least 10% weight loss at week 36, compared with 0.8% on monotherapy (P <.001).³

Clinicians have long observed higher body mass index blunts response to systemic psoriasis therapy, and 2026 trial data now support treating weight alongside skin and joint disease directly. Within the following Q&A interview, Saakshi Khattri, MD, discusses the evolving oral and combination treatment landscape for psoriasis and psoriatic arthritis:

HCPLive: How are new oral treatment options changing the conversation around psoriasis therapy?

Khattri: I'm super stoked to have oral options that have biologic-like efficacy, if I can use that terminology, because historically we've had injectables and we've not had really good oral options that get you clear skin. That's the biggest shift we're seeing in the treatment of psoriasis right now: we have oral options, one that's been approved a few months ago, and others in the pipeline with different MOAs, like the TYK2 inhibitors, that have efficacy comparable to what we'd expect with systemic biologics. It's exciting times to be a psoriasis patient and a prescriber in the psoriasis space, so there's a lot to look forward to.

HCPLive: New data presented at AAD showed adding weight-loss drugs to standard therapy improved outcomes in psoriatic disease. How has this changed your approach?

Khattri: Yes, a few months ago we had presentations at the AAD, and not just the AAD but also in the rheum space, in PsA, on combination therapy with weight loss medications and biologics. It showed patients on combination therapy with weight loss medications and biologics for either psoriasis or psoriatic arthritis tend to perform better than patients who were just on biologics for psoriasis or PsA alone. It's exciting, because we know psoriasis and psoriatic arthritis patients have metabolic syndrome, and they tend to have a high BMI. There's data to support patients with a higher BMI don't necessarily respond as robustly to the systemic options we have, or they're more recalcitrant to options that would otherwise work for somebody with a lower BMI.

So to have this in a clinical trial format that shows efficacy of combination therapy is exciting, because we now have data to go by. I think we suspected it would be the case, but until you have a clinical trial that shows efficacy, it's hard to say yes or no. Now, because of that, more and more of my patients are asking me for combination therapy, and I'm advocating for it in my practice for patients who are eligible for weight loss medications based on their BMI and other comorbid conditions.

HCPLive: Are you optimistic about combination therapy, cautiously optimistic, or waiting for more data?

Khattri: We've had weight loss drugs for a while now, so we have other indications for which they've been used, and there's a lot of chatter around systemic inflammation with weight loss medications as well. I'm pretty excited to have this now in a clinical trial format with data to support combination therapy use. I'm definitely a proponent in my practice of advocating for it, should a patient meet the criteria for an add-on of a weight loss medication.

I think this has also made the discussion around weight loss or high BMI less of an issue, because historically, talking about a patient's weight has been a sore point, or something that can rub people the wrong way, and clinicians are often hesitant to talk about high BMI in our patients. But with this, people are more open to having the conversation, and I think that's the best outcome that has come from this.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Khattri’s relevant financial disclosures include LEO Pharma, Galderma, Eli Lilly, and Johnson & Johnson.

References

1. Johnson & Johnson. FDA approval of ICOTYDE (icotrokinra) ushers in new era for first-line systemic treatment of plaque psoriasis with a targeted oral peptide. Published March 18, 2026. Accessed August 25, 2026. https://www.jnj.com/media-center/press-releases/fda-approval-of-icotyde-icotrokinra-ushers-in-new-era-for-first-line-systemic-treatment-of-plaque-psoriasis-with-a-targeted-oral-peptide.

2. Takeda. Takeda's zasocitinib delivered rapid and durable skin clearance in phase 3 trials. Published March 28, 2026. Accessed August 25, 2026. https://www.takeda.com/newsroom/newsreleases/2026/zasocitinib-phase3-clinical-trial-results/.

3. Merola JF, Mease P, Kivitz A, et al. Ixekizumab with tirzepatide achieved greater disease control than ixekizumab alone in adults with psoriatic arthritis and overweight or obesity. Arthritis Rheumatol. 2026. doi:10.1002/art.70134.