Oral IL-23 Therapies in Psoriasis: Addressing Undertreatment, Adherence, and Patient Preference

In this interview, Dr Andrew Blauvelt discusses his session, "Masterclass: Transforming Psoriasis Care: Oral IL-23 Therapy and the Next Frontier in Patient-Centered Treatment," presented at the 2026 Masterclasses in Dermatology in Sarasota, FL. He explored how emerging oral IL-23 therapies may address persistent gaps in psoriasis care, including undertreatment and nonadherence.

Learn how agents like icotrokinra compare with injectable IL-23 and IL-17 biologics in efficacy, safety, and patient preference—and how clinicians can better integrate shared decision-making into long-term psoriasis management.

Andrew Blauvelt, MD, MBA, is the owner of Blauvelt Consulting, LLC in Annapolis, MD. 

Transcript

What persistent gaps in psoriasis care, such as undertreatment and non-adherence, do you believe oral IL-23 therapies are best positioned to address?

Dr Blauvelt: So we know that there are many great available treatments for psoriasis these days. Most of the best treatments are biologic therapies.

However, many patients prefer oral therapies, and so when we look at the oral therapy space, we see drugs right now that are not quite as efficacious, maybe not quite as tolerable as the biologic medications.

So, if we're looking purely on efficacy, biologics are clearly the winner now over oral therapies.

But we know patients, many of them prefer oral therapies, yet we don't have the greatest drugs there. So, there is a need for better oral therapies in the psoriasis space.

How do emerging oral IL-23 agents compare to injectable IL-23 inhibitors and small molecules in terms of efficacy, safety, and patient experience?

Dr Blauvelt: So there's one new IL-23 inhibitor that has been studied in recent years. We've seen recently Phase 3 data on that drug. It's called Icotrokinra.

And this drug is a peptide that binds to the IL-23 receptor and keeps normal IL-23 from being bound to that receptor, so it blocks IL-23 signaling, so an oral IL-23 inhibitor. It's a completely novel mechanism.

When we look at the efficacy of this drug, we see that it is better than currently available oral drug options. Number one, it appears to be safe.

No issues, and that's expected because it's blocking IL-23, and we know that anti-IL-23 biologics are very safe. So, it looks like it might be emerging to be the best oral drug available for treatment of psoriasis. Now, how does that compare with our biologic therapies?

I think it's better in terms of efficacy than many biologics, and that's a great thing to say. However, when we look at the very best biologics in psoriasis, some of the top IL-17 inhibitors, some of the top IL-23 inhibitors, we still see efficacy with those top biologics that are better than Icotrokinra.

So, the best oral efficacy we've seen to date, but not quite in the class of the very best IL-17 and IL-23 inhibitors. But as I mentioned, many patients prefer orals, and this would be a great advance, because it does take efficacy right into the middle of the biologic range.

What practical steps can clinicians take to integrate patient preferences into psoriasis treatment planning while balancing long-term disease control?

Dr Blauvelt: I think, physicians need to talk to patients about their options.

And, there, as I mentioned, are many good options to treat psoriasis. We still see untreated moderate-to-severe plaque psoriasis. We still see under-treated moderate-to-severe plaque psoriasis. It's a shame, given all the great drugs we have.

And so, again, I think, not automatically going to biologics, giving patients an oral option that is, great efficacy, great safety, comparable to many biologics, I think is a great thing. And so I encourage, clinicians out there to really discuss the options with their patients, both biologic therapies, if they want the very best efficacy, but the best evolving oral drugs as well that is comparable in many ways to biologic therapy.