Promising Drugs in the Pipeline for Atopic Dermatitis, Psoriasis, HS

Kenneth Gordon, MD, a dermatology professor at the Medical College of Wisconsin, presented on the future of dermatology at the 2025 Society of Dermatology Physician Assistant (SDPA) on Friday, June 27th. During his talk, he discussed current and future treatments for atopic dermatitis (AD), psoriasis, and hidradenitis suppurativa (HS).

Starting with AD, many current treatments block interleukin (IL)-4 and IL-13. On the market, there are dupilumab, tralokinumab, and lebrikizumab. There are also JAK-1 inhibitors, including upadacitinib and abrocitinib.

“Remember, next time someone says, ‘Oh, just use a JAK inhibitor,’ say, ‘Which one and what cytokines and which receptors are you trying to block?” Gordon said during the talk. “They'll look at you very confused, but it's an important question.”

He said it is exciting that there are 2 OX40 blockade drugs in the pipeline: amlitelimab and rocatinlimab. These drugs work by blocking the T cell activation complex that leads to AD. In the STREAM0AD trial, amlitelimab significantly reduced numerous plasma proteins associated with Th2 and Th1.

The ROCKET-Horizon trial examining rocatinlimab for AD also showed promise. Based on the data, rocatinlimab may be more effective than amlitelimab.

“But remember, the goal here is to get long-term benefit along with short-term value,” Gordon said. “So, while these things are not overwhelmingly effective in the long term, we don't have the data for 2,3,4 years down the road, and that's what we'll need to see, but sometimes we get surprises as well.”

Studies have also shown the promise of GSK1070806, an IL-18 target, for moderate to severe AD. This improves AD at very early stages.

“What does this tell us? It tells us sometimes we get lucky,” Gordon said. “So, this drug was being used and developed for inflammatory bowel disease, and some patients with atopic dermatitis got it got better.”

During his talk, he stressed that researchers conduct real clinical trials, not just case reports. He provides the example of cimetidine for warts. In 7 cases, cimetidine improved warts, but then later 2 randomized controlled trials showed cimetidine provided no benefit, although not harmless.

Gordon moved on to discussing current treatments for psoriasis. Oral options include methotrexate, acitretin, cyclosporine, deucravatinib, and fumaric acid. Available biologics include anti-TNF (etanercept, infliximab, adalimumab, certolizumab, biosimilars), anti-IL-17 (secukinumab, ixekizumab, brodalumab, bimekizumab), and anti-IL-23 (Ustekinumab, guselkumab, tildrakizumab, risankizumab).

The pipeline includes zasocitinib, an oral TYK2 inhibitor, which is effective at blocking IL-17. This drug attempts to block 90% of IL-17.

“Now, is that necessary, or is that going to show any value? We'll see. The phase 3 data here is probably going to be available…in the next year,” Gordon said.

Another drug that shows promise for psoriasis is icotrokinra, a small protein delivered as a pill, which blocks IL-23 R and IL-23 signaling. Icotrokinra acts like a biologic and provides long-term benefit. Until more research comes out, it is not known whether icotrokinra will be more effective than the new TYK2.

Gordon finished his talk discussing HS; available drugs for this disease include adalimumab, secukinumab, and bimekizumab. The pathophysiology of HS is not well understood since a lot of different things occur in different stages of the disease.

A 16-week phase 2 trial examined HiSCR50 and HiSCR75 for HS, showing promise. Phase 3 trials are underway.

“You have to understand what's going on to understand what you're doing,” Gordon said. When you just look at, say, oh, TYK2 is a JAK…you're really giving a disservice to your patients. You're really not understanding what's going on with that agent. You have to think about why it's working, how it's attacking.”

References

Gordon, K. The Future of Dermatology: Innovations on the Horizon. Presented at SDPA 2025 on Friday, June 27th, in Washington, DC.