Oral IL-23 Blocker Icotrokinra Sustains High Clearance in Scalp and Genital Psoriasis

Johnson & Johnson has announced new 52-week results from the Phase 3 ICONIC-TOTAL study evaluating icotrokinra—a first-in-class, oral peptide that selectively blocks the interleukin-23 (IL-23) receptor—in adults and adolescents (≥12 years) with plaque psoriasis (PsO) involving high-impact and difficult-to-treat areas such as the scalp, genitals, hands, and feet. Data were presented at the 2025 Fall Clinical Dermatology Conference.

Key Efficacy Findings

• Site-specific clearance:
• Scalp psoriasis: 72% achieved scalp-specific Investigator’s Global Assessment (ss-IGA) 0/1 (clear/almost clear); 57% achieved ss-IGA 0 (complete clearance).
• Genital psoriasis: 85% achieved Physician’s Global Assessment of Genitalia (sPGA-G) 0/1; 73% achieved sPGA-G 0.
• Hand/foot psoriasis: hf-PGA 0/1 improved from 42% at Week 16 and increased to 62% at Week 52.
• Overall disease control:
• 67% of patients achieved IGA 0/1 by Week 24, sustained through Week 52.
• 44% achieved complete skin clearance (IGA 0) by Week 52.
• Results were comparable between continuous icotrokinra users and those who switched from placebo at Week 16 (67% vs 68% IGA 0/1, respectively).

Safety and Durability

• Safety profile remained consistent through Week 52, with no new safety signals identified.
• Adverse and serious adverse event rates were comparable to those seen through Week 16.
• The data reinforce icotrokinra’s favorable tolerability and durable response with once-daily oral dosing.

According to study investigator Edward (Ted) Lain, MD, MBA, executive director of the Austin Institute for Clinical Research, “Many of the patients in my practice experience significant distress when psoriasis affects sensitive areas such as the scalp, genitals, hands, and feet. The durable response rates observed in the ICONIC-TOTAL study show that icotrokinra has the potential to be a meaningful new option for effectively managing moderate-to-severe plaque psoriasis long-term in both adults and adolescents.”

Therapeutic Implications

These findings further strengthen the clinical profile of icotrokinra as a targeted, non-biologic oral option that delivers biologic-like efficacy by directly blocking IL-23 receptor signaling.

• Potentially expands treatment options for patients with moderate-to-severe PsO seeking high clearance rates without injections.
• Ongoing Phase 3 ICONIC program also includes studies across psoriatic arthritis, ulcerative colitis, and Crohn’s disease, underscoring its broader therapeutic potential across IL-23–mediated disorders.

“Psoriasis that affects high-impact skin sites often results in greater physical discomfort for patients due to the sensitivity of these areas,” said Liza O’Dowd, MD, vice president, Immunodermatology and Respiratory Disease Areas Lead, Johnson & Johnson Innovative Medicine. “Icotrokinra is being developed with the goal of setting a new standard of treatment that offers patients the precision of a targeted therapy, high level skin clearance and favorable safety profile with the ease of a once daily pill.”