Tildrakizumab has already been FDA approved for psoriasis. Patients typically receive it in-office as a once-every-12-week injection, which Dr. Ogdie noted is often helpful for medication access in Medicare patients.
In contrast, icotrokinra is an oral IL-23 receptor antagonist peptide presently under development for plaque psoriasis.12 Dr. Ogdie noted that it appears to be effective for skin manifestations, like other anti-IL-23 agents. Some early findings presented at ACR Convergence 2025 have shown promise in subsets of psoriasis patients who also have psoriatic arthritis, so further research exploration in psoriatic arthritis is expected.13
Tyrosine Kinase 2 Inhibitors
Tyrosine kinase 2 (TYK2) is one of the Janus kinase (JAK) immune signaling enzymes. It is thought to potentially have more signaling through the IL-23 pathway compared with the other Janus kinases; moreover, TYK2 inhibitors are more selective than traditional JAK inhibitors, potentially leading to an improved safety profile.
Deucravacitinib is a novel oral TYK2 inhibitor already FDA approved for psoriasis. The positive phase 3 POETYK1 and POETYK2 trials further explored results in psoriatic arthritis, with results released at the most recent EULAR Congress. Dr. Ogdie noted that the drug might be appropriate for a similar patient subset as those currently taking oral apremilast, which causes much more nausea and diarrhea.14 “This could be a much more tolerable once-a-day oral medication for a similar population,” she said.
Zasocitinib is a similar investigational oral agent with positive results in phase 2 trials for psoriatic arthritis, but one with even greater selectivity for TYK2 inhibition.15 “We’ll have to look down the line at potential differences between the molecules,” said Dr. Ogdie.
Dr. Ogdie also commented on the increased risk of acne in these agents, which can also occur with JAK inhibitor treatment, so clinicians should check in with patients about this treatable side effect.
Overall Treatment Approach
Even with multiple biologic treatments available, and more on the horizon, only about a third of patients with psoriatic arthritis have minimal disease activity within six months of starting a biologic or targeted synthetic disease-modifying anti-rheumatic drug.7 Making real progress will probably require not just new agents but also new ways of employing them and finding the right therapies for different subsets of patients.
Although Dr. Ogdie’s talk centered on new therapies for psoriatic arthritis, she also emphasized the need to explore new treatment strategies and additional approaches to help patients feel better overall, independent of direct pharmacological interventions.
