Optimizing Outcomes with Oral Therapies in Plaque Psoriasis - Episode 5
Understanding the Pathophysiology of PsO
Advances in psoriasis biology are translating key inflammatory pathways into increasingly precise oral treatment targets.
In this episode, ‘Understanding the Pathophysiology of PsO,’ the expert dermatology panel explores how advances in psoriasis pathophysiology have led to increasingly targeted therapies. The discussion traces the evolution of understanding from earlier concepts of psoriasis as a predominantly TH1-mediated disease to recognition of the central role of the IL-23/TH17 pathway.
The faculty describe how basic science discoveries surrounding IL-23 and TH17 cells directly contributed to the development of highly effective IL-17 and IL-23 biologic therapies. They then explain how similar mechanistic insights have driven innovation in oral treatment. Apremilast targets PDE4, an intracellular molecule involved in the generation of multiple pro-inflammatory cytokines, while deucravacitinib inhibits TYK2, which participates in intracellular signaling downstream of cytokines including IL-12 and IL-23.
The panel also discusses the emergence of icotrokinra, an oral peptide that targets the IL-23 receptor itself. Rather than neutralizing circulating IL-23 in the manner of a biologic, icotrokinra binds the receptor and prevents IL-23 signaling. Faculty consider this approach an important example of how traditionally biologic targets may increasingly become accessible through oral therapies.
The next episode in this series, ‘Individualizing Oral Therapy Selection for Patients With PsO,’ features the panelists discussing which patients may prefer oral therapy and how disease characteristics, convenience, efficacy, comorbidities, and treatment goals guide selection among available options.
