A Once-Daily Pill for Hard-to-Treat Psoriasis Holds Up Over Two Years

Plaque psoriasis affects more than 8 million Americans, and for many, the disease shows up in places that are especially hard to live with and hard to treat, such as the scalp, genitals, hands and feet. New two-year data presented at the European Academy of Dermatology and Venereology Congress suggest that an oral treatment can keep those areas clear over the long term.

Johnson & Johnson announced results from the phase 3 ICONIC-TOTAL trial of Icotyde (icotrokinra), a once-daily pill that targets the IL-23 receptor, a key driver of psoriasis inflammation. The Food and Drug Administration approved Icotyde in March 2026 for adults and children 12 and older who weigh at least 88 pounds (40 kilograms) and have difficult-to-treat plaque psoriasis.

Clearance that lasted through two years

Among patients taking Icotyde, rates of clear or almost clear skin rose from 57% at week 16 to 67% at week 24 and 70% at week 112. At week 112, complete clearance rates were:

• 60% for scalp psoriasis
• 89% for genital psoriasis
• 63% for psoriasis on the hands and/or feet

Nail psoriasis also improved over time, with average improvement increasing from 33% at week 16 to 62% at week 52 and 71% at week 112. Safety findings through week 112 were consistent with earlier results, and no new safety concerns emerged. In earlier trials, the most common side effects included headache, nausea, cough, fungal infection and fatigue.

The Educated Patient asked Liza O’Dowd, M.D., vice president, immunodermatology and respiratory disease areas lead at Johnson & Johnson Innovative Medicine, what the findings mean for patients.

This is two-year data, well past the initial 16-week and one-year readouts most psoriasis trials lead with. Why does durability at this length matter for how you and other clinicians think about a treatment's role, especially for a chronic, lifelong condition like this?

Liza O’Dowd, M.D.: Psoriasis is a lifelong disease, so patients need more than a treatment that works initially. They need results that last. What is encouraging is that with Icotyde, we are seeing strong, sustained skin clearance through two years, including in areas like the scalp, genitals, hands and feet that can have an outsized impact on daily life. For patients and physicians making long-term treatment decisions, that sustained response, together with a favorable safety profile and the convenience of a once-daily pill, reinforces Icotyde as a preferred first-line systemic treatment for plaque psoriasis.

The genital psoriasis clearance rate, 89% at week 112, stands out even among the other high-impact sites. Is there something specific about how Icotyde works, or about this patient population, that explains why that number is so high?

LO: The 89% complete clearance rate for genital psoriasis at week 112 is certainly encouraging. While we can’t speculate beyond the data, genital psoriasis is considered a high-impact site because even a relatively small area of involvement can have a significant effect on patients’ comfort, intimacy, sexual health and overall quality of life. It has also historically been challenging to treat because the skin in these sensitive areas can limit the use of some topical therapies. That’s why seeing very high rates of skin clearance in the genital area is particularly meaningful.

You've said patients with high-impact site involvement deal with severe functional disability and daily pain, even when the affected area is small. Can you walk us through what that disconnect between visible surface area and actual impact looks like for patients?

LO: High-impact sites are a good example of why the amount of skin involved doesn’t always tell you the full story of the psoriasis burden. A relatively small patch on the hands or feet can make it difficult to work, walk or carry out everyday activities; involvement of the scalp can be highly visible and hard to conceal; and genital psoriasis can affect comfort, intimacy and sexual health. So even if the overall body surface area involved is small, the impact on a patient’s daily life can be significant. That’s why sustained clearance in these areas can be particularly meaningful to patients.

Many patients with plaque psoriasis cycle through multiple topical or conventional treatments for years before finding something that works. What does Icotyde's mechanism, an oral peptide that targets the IL-23 receptor, offer that makes it a candidate for first-line systemic treatment rather than another step in that cycle?

LO: What makes Icotyde different is that patients don’t have to make trade-offs between the convenience of an oral treatment and the precision of a targeted therapy. As the only targeted oral peptide designed to precisely block the IL-23 receptor, Icotyde brings those attributes together in a once-daily pill. Importantly, we now have two-year data showing sustained responses with a consistent favorable safety profile. That combination is why Icotyde is such an important first-line systemic option for adults and adolescents with moderate to severe plaque psoriasis and gives physicians an opportunity to move appropriate patients beyond repeated cycles of topical therapy sooner.

With safety findings remaining consistent through week 112 and no new signals identified, what would you want a patient who's hesitant about starting a systemic treatment to understand about the long-term safety picture at this point?

LO: For a chronic disease like psoriasis, where patients may remain on treatment for years, understanding the safety profile with long-term treatment is very important. Rates of adverse reactions for Icotyde-treated patients were within 1.1% of placebo through week 16, and no new safety signals were identified through week 112.