Targeted Oral Peptide Icotrokinra for Psoriasis Involving High-Impact Sites

BACKGROUND: Plaque psoriasis involving high-impact sites is difficult to treat. Icotrokinra, a targeted oral peptide that selectively binds interleukin-23 receptors, is a new treatment being investigated for this condition. METHODS: This phase 3, double-blind, placebo-controlled trial randomly assigned participants 12 years of age and over with plaque psoriasis {with a body surface area ≥1%; an Investigator's Global Assessment (IGA) score ≥2 [clear (0), minimal (1), mild (2), moderate (3), and severe (4)] for overall skin; and at least moderate psoriasis involving the scalp, genitalia, and/or hands and feet} to receive either icotrokinra 200 mg daily or placebo in a 2:1 ratio. The primary end point at week 16 was the proportion of participants achieving an overall IGA score of 0 or 1 and an improvement of 2 points or more from baseline (IGA score of 0 or 1), reported as the between-group difference adjusted for high-impact site involvement, geographic region, and body surface area category using Mantel-Haenszel weights. Absent/clear or minimal/almost clear scalp, genital, and/or hand and foot psoriasis at 16 weeks were secondary end points. Adverse events were recorded. RESULTS: The trial randomly assigned 311 participants (icotrokinra, n=208; placebo, n=103) with scalp (n=252: icotrokinra, n=167; placebo, n=85), genital (n=140: icotrokinra, n=98; placebo, n=42), and/or hand and foot (n=71: icotrokinra, n=48; placebo, n=23) psoriasis. The proportions of participants achieving an IGA score of 0 or 1 in the icotrokinra and placebo groups were 56.7% and 5.8%, respectively [adjusted difference, 51.1 percentage points; 95% confidence interval (CI), 42.1 to 58.8; P<0.001]. The proportions of icotrokinra-treated and placebo-treated participants achieving absence/clear or minimal/almost clear high-impact site psoriasis were as follows: scalp, 65.9% and 10.6% (difference, 55.5 percentage points; 95% CI, 44.8 to 64.4; P<0.001); genitalia, 76.5% and 21.4% (difference, 55.4 percentage points; 95% CI, 39.1 to 68.0; P<0.001); and hand and foot, 41.7% and 26.1% (difference, 16.7 percentage points; 95% CI, -6.2 to 36.8; P=0.144). Adverse events occurred among 50% and 42% of participants in the icotrokinra and placebo groups, respectively. CONCLUSIONS: At 16 weeks, significantly higher proportions of participants 12 years of age and over with at least moderate psoriasis involving high-impact sites treated with icotrokinra versus placebo achieved clearance or minimal psoriasis in their skin overall and in the scalp and genital areas, but not in their hands and feet. No safety signals were identified. (Funded by Johnson & Johnson; ClinicalTrials.gov number, NCT06095102.).