Lawrence Eichenfield, MD

A subgroup analysis of the ICONIC-LEAD study had its findings presented at the World Congress of Pediatric Dermatology Annual Meeting, demonstrating that adolescents living with 

 given once-daily treatment with icotrokinra (JNJ-2113) saw increased rates of clear or almost clear skin at 16 weeks versus placebo.

After these data were released by Johnson & Johnson, the 

 editorial team interviewed Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego and professor of dermatology and pediatrics at the UC San Diego School of Medicine, who had been an investigator in this analysis. Here, Eichenfield highlights the study’s 

 and their significance for dermatologists.

Significance of Icotrokinra Findings for Adolescents with Psoriasis, with Lawrence Eichenfield, MD

“I think my big takeaway is that we have incredibly potent results in terms of this drug, with an incredibly good safety profile as well,” Eichenfield explained. “An easy number to walk away with is that there was almost 90% of patients made PASI 90 at 24 weeks, so we didn't even show PASI 75 data…It was 86.6% of patients at 24 weeks, it was 70.5% at the earlier time point of 16 weeks, and very low placebo response rate at 16 weeks.”

In the team’s other primary endpoint, which was an Investigator's Global Assessment (IGA) score of 0/1 (clear or almost clear skin) with a 2-grade improvement at least, 84.1% of subjects at the 16-week mark and 86.4% at the 24-week mark reported such a response.

“You have to mention the safety as well, and the data set is very consistent,” Eichenfield said. “The overall study population data set was as well, which [means there were] not a lot of remarkable adverse events. There happened to be 2 serious adverse events in the adolescent group, but neither of them was considered secondary to the drug. One patient temporarily stopped the drug and went right back on it. Another 1 had been hospitalized for an evaluation, but it was not related to the drug and never stop the drug. Otherwise, it was an unremarkable side effect profile.”

Eichenfield was asked about what these results should mean to dermatologists and health care professionals reviewing the data from his team’s analysis.

“The big picture is that this technology has set up essentially biologic-like efficacy in an oral agent,” Eichenfield explained. “Certainly for adolescent psoriasis with this particular drug, in this particular peptide, I think having the ability to get such rapid effectiveness with a great safety profile, without the need for injectables, and without concerns about blood work, it's really going to be incredibly well received by the dermatology community.”

View the full video posted above to find additional information on this segment of Eichenfield’s interview.

The quotes implemented in this summary were edited for the purposes of clarity. Eichenfield is a paid consultant for Johnson & Johnson.

Icotrokinra results show 75% of adolescents with plaque psoriasis achieved completely clear skin and demonstrate favorable safety profile in a once daily pill. Johnson & Johnson. April 10, 2025. Date accessed: April 11, 2025. 

https://www.prnewswire.com/news-releases/icotrokinra-results-show-75-of-adolescents-with-plaque-psoriasis-achieved-completely-clear-skin-and-demonstrate-favorable-safety-profile-in-a-once-daily-pill-302425136.html

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This segment of the latest interview with Lawrence Eichenfield, MD, features a discussion about the ICONIC-LEAD study.

 released by Johnson & Johnson from a subgroup analysis of the ICONIC-LEAD study were presented at the 2025 World Congress of Pediatric Dermatology (WCPD) Annual Meeting and demonstrated that adolescents with moderate-to-severe 

 treated with once-daily icotrokinra (JNJ-2113) received higher rates of clear or almost clear skin at the 16-week mark versus placebo.

These new data resulted from the first-ever phase 3 registrational analysis of moderate-to-severe plaque psoriasis to assess a systemic medication in adolescents and adults simultaneously. To discuss icotrokinra, the 

 team spoke with Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego and professor of dermatology and pediatrics and vice-chair of the department of dermatology at UC San Diego School of Medicine.

Notable Attributes of Icotrokinra for Adolescents with Psoriasis, with Lawrence Eichenfield, MD

“This is an exciting drug because it's bringing a new technology into the space that had basically been inhabited by injectable biologics,” Eichenfield explained. “We know that in pediatric psoriasis or adolescent psoriasis, something that's common, almost a third of adults relate that they had onset of their psoriasis in adolescent years or earlier. And most of our highest level efficacy medications for psoriasis were injectables.”

Eichenfield highlighted that what he finds exciting about icotrokinra is that the medication is a oral peptide formulated to block interleukin (IL)-23 at the receptor level. IL-23 is a potent regulator of psoriasis, Eichenfiled noted, with a variety of downstream effects on IL-17A, IL-17F, and IL-23.

“This is an oral agent, an oral blockade that can block IL-23 effects,” Eichenfield said. “Previously, we've seen in the phase 2 trials and the combination phase 3 trials great efficacy and safety.”

Eichenfield also discussed the phase 3 ICONIC-LEAD’s design, highlighting that the randomized control trial was set up to evaluate icotrokinra’s efficacy and safety versus placebo among a total of 684 trial participants. He later highlighted various elements of the study and the recent findings on icotrokinra.

For additional information on this segment of Eichenfield’s interview, view the full interview posted above.

The quotes used in the above summary were edited for clarity.

Eichenfield reports being a paid consultant for Johnson & Johnson.

In this interview, Lawrence Eichenfield, MD, speaks on his team’s recent research on icotrokinra for patients with moderate-to-severe plaque psoriasis. 

 Leon, how do you anticipate the treatment landscape evolving with JAK inhibitors and in addition to JAK inhibitors?

 Let me first go over the topical JAK inhibitors. They will really change the landscape. I can’t remember who it was, but somebody said they will probably be really useful for maintenance treatment. I agree with that, because we want to prevent the disease from coming. We have more or less good tools to get rid of the flares. Now we have dupilumab. We have topical steroids; they work really well for a week or two. The problem is we want to make the next flare as far away as possible and decrease the number of the flares. How do we get that? How do we maintain that clearance? Topical JAK inhibitors can be a great tool to do that. That’s one.

Two was brought up by Lisa. With the oral JAK inhibitors, the main use will be just for flares, right? If dupilumab doesn’t work or if something else doesn’t work, why not have another agent, that very short targeted treatment, for a couple of weeks—4 weeks, 8 weeks, whatever the period is—just to get that flare over and avoid the long-term safety issues without worrying about it. Also, they’re orals. Nobody wants a shot, but people use it because they have no other choice. Now we’ll have another choice.

 Peter, did you want to weigh in on the treatment landscape? Do you think we’re going to get more patients, or do you think we’ve seen them all? Do you see this as continued evolution and better care?

 I do hope and think we’ll see this expanding out to a lot of the people who have given up on the medical system. I meet some patients who are coming out of the woodwork because they’ve gotten the same diagnosis and treatment regimen, something like a big 1-lb jar of triamcinolone with 11 refills and were told, “Good luck.” But now they’re understanding we have new insight into the disease and new treatments. I’m seeing more patients. And we know if the numbers are correct, we’ve only seen a drop in the bucket of all these patients who are moderate, severe, and uncontrolled. Our treat-to-target keeps getting better and better. Just like what we saw with psoriasis where we used to accept, “That’s pretty good on methotrexate, you’re hanging in there,” now we’re aiming for clear or almost clear for these patients. The same is happening to atopic dermatitis. I’m excited.

 That’s great. Peter, I’m going to stay with you because you’re such an important figure in educating practitioners about atopic dermatitis. You’ve been very influential. With this changing and dynamic aspect of therapeutics, what are your recommendations for primary care practitioners [PCP] on best practices for collaborating on care and patient selection for referral?

 If I could get everybody to write out an eczema action plan, that would do 90% of the work. It’s a pain in the neck. It’s a lot of work. It takes some coordination. It takes a few extra moments, but even if it’s just some scribbles, just to give the patient a sense of where they’re going, it’s is an incredibly powerful tool that can be integrated into anybody’s practice. If you do it in a digital template, you can also copy and paste it into your notes. Now you know exactly what you told the patient. You print it for the patient so they have exactly what you’ve recommended in the order of operation, when they’re flaring up, when they’re better. It’s such an elegant thing.

As Lisa pointed out, we have those great hurdles. “Can I get you clear? Can I keep you clear safely, and can you keep it up?” Any time a patient can’t jump over one of those hurdles, that’s absolutely a reason to refer. And frankly, that applies to me, too. I have really tough patients where I’m not sure and I say, “I want another opinion. We can’t get you better, so let’s get someone else involved.” There’s no shame in that. I always try to remind our PCP colleagues that dermatologists do a fair amount of primary care medicine, so there’s no stupid consult. There’s nothing that we think is dumb. People come in for skin screening all the time, so we’re very much used to people who just want to get a check over. And in that capacity, any patient who is referred by another provider who says, “Listen, I’m not sure what’s going on,” or “I’m not able to help them,” we want to help to try to get them better. We’re all part of the same team. Our goal is not to be right, it’s not to be famous, it’s to get the patients better.

 That’s great. I’ll add to that. It sounds silly to say, but there’s consciousness raising about the disease. Even as experts who deal with a lot of atopic dermatitis on a daily basis in our practices, I’m more cognizant of what the disease impact can be. That’s across the whole spectrum.

One of the things as part of messaging to primary care is, if you’re watching this, great. The point is to get educated about the disease and recognize it. Change the messaging. For pediatricians, I talk about the asthma model because they understand an asthma model. It’s about long-term disease control and figuring out what medicines you need. And if you need someone beyond you to establish long-term disease control with minimal rash, minimal itch, and minimal sleep disturbance, then send them out. Certainly, I’m in the situation where, as Peter said, there are times it’s like, “I need an immunologist. Help me, please.”

Part of best practices is recognizing when the patients outstrip what you are able to bring to it. But also be alert to the changes that are going to happen in therapies because a lot of those are going to be incorporated into primary care practice, too, even though it may be specialists who are leading us toward that.

Let’s go to the last area of discussion on how we educate patients and their caregivers to keep them up to date on the management of atopic dermatitis. Does anyone else want to come into that, or should Peter go back to it? Peter, why don’t you lead us off on that? What’s your sense or your approach on keeping people up to date?

 It’s hard, because even we are feeling a little of that drowning sensation with so many papers. I did this plot, I used one of the scholar sites and was able to show that the number of publications in atopic dermatitis in the past decade looks exponential, and I feel like it’s going to keep going up.

What are some things I think are helpful? Certainly things like this. These are great because you get to hear a lot. Even I learn a lot from these meetings, because you get to hear the digested form of a lot of primary data, a lot of exposure to papers, and the chance to talk to our colleagues. There are many online things like this.

Another great thing to do is use email digests for topics. I use one that’s actually from the Google search engine, and I have targeted certain things so it gives me little digests every day—or you could set it every week—and I think that’s a nice way to see the papers just to read the headlines or read an abstract. And then if you’re really interested, you can click in and learn a little more.

Of course, there are some innovative things. I’m excited to be working with a group that’s creating medical video games for education. They’ve packaged, somewhat like the Duolingo language learning website and app, it’s the same concept with CME [continuing medical education]-type activities for different specialties. I love this kind of innovative thing. And then finally, I really do think that reading journals is still important. Even though we somewhat let go of them, they’re still important and I still like to flip through my journals even physically when I can, even though that dates me.

 This was an incredible discussion, really capturing some of the breadth of the issues that we deal with in atopic dermatitis. I thank you all for your contributions to the discussion. It was so reflective of where we are. I hope you get a chance to do this together with such experts. I thank all of you for contributing both your knowledge and experience with patients, and the energy that you bring to this arena of atopic dermatitis as we work together to bring better care and hopefully less influence of the disease on the life of individuals.

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Closing out its discussion on atopic dermatitis, the panel considers best practices and unmet needs in the treatment landscape.

Atopic Dermatitis: An Evolving Treatment Landscape

 That’s a great segue into the last segment of our discussion, which is a mixture of core questions for us to summarize where we’re at and what we’ve discussed through this session.

Let me start off. Lisa, discuss how and when you decide to make a change in therapy.

 For me, it’s pretty straightforward. If I can’t get a patient clear or keep them clear, then I’m going to be discussing and encouraging a change because I want to make these patients’ lives better. I want to make them look better, feel better, and do better. If I can’t get them clear or keep them clear, we should try something different. Fortunately, our option list is growing longer by the day.

 What else? Are there other times you’d like to make a change in therapy? I’m not big on changing it because someone else already used it. About half the time, people come in and they just haven’t used enough of a medicine. I don’t necessarily write a new script, I just write a more detailed care plan and do volumetric prescribing, where I tell them a certain volume. In all of medicine but especially in dermatology conditions, what’s needed in each room isn’t just walking in, making the diagnosis, and prescribing something. Partially our decision about when to change therapy and how we change therapy is individualized according to what that particular patient might need.

A brief discussion on when it is best to switch therapy while treating patients for atopic dermatitis.

Lawrence Eichenfield, MD

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