Takeaways on Icotrokinra and Psoriasis for Clinicians, With Linda Stein Gold, MD

In the second part of her interview, Linda Stein Gold, MD, of Henry Ford Health System, touched on the gap between what topicals can realistically offer and when systemic therapy should enter the picture, how icotrokinra's oral profile can change the conversation among hesitant patients, and where she hopes the research goes following the US Food and Drug Administration (FDA) approval.1,2

When asked by the HCPLive editorial team what primary care clinicians should take away about recognizing when a psoriasis patient has outgrown topical therapy, Stein Gold opened with a candid observation about a pattern she sees across the field: treatment inertia.

“We tend to have treatment inertia,” Stein Gold said. “When it comes to our psoriasis patients, we put them on a topical medication. Maybe they're not doing so well, so maybe we think about another topical medication, and we don't always progress to a systemic medication, probably as quickly as we need to first.”

Her message to primary care providers suggests when topical therapy is not delivering meaningful improvement, it may be time to consider a systemic option rather than cycling through more of the same. This framing set up Stein Gold’s response to the second question, which inquired as to how a clinician might reopen the systemic therapy conversation with a patient who has previously declined injectables.

Stein Gold's answer centered on what icotrokinra can provide as an oral agent. She pointed to the nature of psoriasis as a systemic disease driven by systemic inflammation, particularly in those living with moderate to severe plaque involvement, and that treating the whole patient means addressing that underlying pathway rather than managing surface symptoms alone.

Icotrokinra targets the interleukin (IL)-23 receptor, which she described as a key receptor in a pathway now well understood and recognized as central to the pathogenesis of psoriasis. For individuals who have resisted treatment escalation because of a fear of injections, Stein Gold pointed to icotrokinra's once-daily oral dosing on an empty stomach in the morning as removing the primary barrier.

Efficacy begins within the initial few weeks of use and builds through the primary 16-week endpoint and beyond. The trial data, Stein Gold noted, gives her genuine confidence in recommending the drug to systemic candidates across age cohorts. On the question of what she hopes comes next for icotrokinra research, Stein Gold was specific and forward-looking.

She expressed hope for continued investigation into psoriatic arthritis (PsA), described as the natural next step in research on icotrokinra given how central the IL-23 pathway is to both skin and joint disease. She also made a point of flagging the pediatric age gap. While the current FDA approval extends down to age 12, she noted psoriasis does not begin at 12 and describes an oral option for an even younger population as a meaningful advance.

Disclosures: Stein Gold has reported serving as an investigator, advisor, or speaker for AbbVie, Amgen, Arctis, Bristol Myers Squibb, Dermavant, Eli Lilly, Johnson & Johnson, Novartis, Pfizer, and UCB. AWA has served as a research investigator, scientific advisor, or speaker to AbbVie, Amgen, Arcutis, BMS, Boehringer Ingelheim, Dermavant Sciences, Eli Lilly, Galderma, Incyte, Johnson & Johnson, Leo Pharma, Novartis, Parexel, Pfizer, Regeneron, Sanofi, Takeda, and UCB. RB is an advisory board member, consultant, speaker, investigator for, or received honoraria or grants from AbbVie, Alumis, Amgen, AnaptysBio, Arcutis, BMS/Celgene, Eli Lilly, Johnson & Johnson, LEO Pharma, Organon, Nimbus, Takeda, UCB, VentyxBio, Vyne, Xencor, and Zurabio, and is also an employee and shareholder of Innovaderm Research.

References

1. Campbell P. Icotrokinra, an Oral Il-23 Inhibitor, Receives FDA Approval for Psoriasis. HCPLive. March 18, 2026. Accessed March 20, 2026. https://www.hcplive.com/view/icotrokinra-receives-fda-approval-for-psoriasis.

2. Johnson and Johnson. FDA approves ICOTYDE (icotrokinra), the first and only targeted oral peptide IL-23 receptor antagonist, for the treatment of moderate-to-severe plaque psoriasis. Press release. Published March 18, 2026. Accessed March 20, 2026. https://www.jnj.com/media-center/press-releases.