Positioning Icotrokinra as First-Line Therapy for Plaque Psoriasis

This episode, titled ‘Positioning Icotrokinra as First-Line Therapy for Plaque Psoriasis,’ features panelists making the case for first-line use.

Andrew Mastro, MS, PA-C, widens the lens and asks Alexa Hetzel, MS, PA-C, where icotrokinra sits within the broader plaque psoriasis landscape, including whether route of administration itself shapes patient preference. Hetzel says icotrokinra has become her first-line choice over other oral therapies in the roughly 12 weeks she has had access to it. She adds that it also holds value even before biologic therapy is considered, since patients in the clinical trials who had previously tried and either failed or lost insurance coverage for a biologic still responded to the oral peptide. Because no single therapy works for every patient, Hetzel says the goal is not a one-size-fits-all answer but a wider set of options that increases the odds any given patient finds one that works long term.

Hetzel also flags a messaging shift she considers important: earlier oral agents were sometimes positioned as a stepping stone toward eventual biologic therapy, but she does not see icotrokinra the same way, pointing to sustained response through 52 weeks as evidence it can serve as a durable, standalone choice rather than a bridge.

Asked to name the single most practice-changing takeaway from the discussion, Hetzel offers three. First, icotrokinra works through a mechanism, IL-23 receptor inhibition, that clinicians are already comfortable with, lowering the barrier to adoption. Second, she urges clinicians to use updated guidelines not just to guide their own prescribing but to advocate for patients facing insurance denials or delays in accessing systemic therapy. Third, and somewhat unprompted, she raises the simple importance of patients answering the phone, noting that even the most effective therapy cannot help a patient who does not follow through on next steps. Hetzel likens hesitant patients to an online shopper who saves an item for later rather than checking out, and stresses that clinicians have to actively walk patients through that final step rather than assuming they will follow up on their own.

In the next episode, ‘The Future of Plaque Psoriasis Treatment Over the Next 3 to 5 Years,’ Mastro and Hetzel look ahead at how the treatment paradigm may continue to evolve.