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IL-23 Blockade Goes Oral

Aurelie Najm, MD, PhD

A new player is entering the IL-23 arena — and it’s a tablet! Icotrokinra (ICO), a first-in-class peptide that binds and blocks the interleukin-23 receptor (IL-23R), is showing encouraging efficacy and safety across a range of psoriasis (PSO) and psoriatic disease (PsD) studies.

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Eating Crow (10.10.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, FDA approvals, and journal articles. In this episode: HMGCR Abs, FDA approvals and Cush eats crow.

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Guselkumab FDA Approved for Pediatric Psoriasis and Psoriatic Arthritis

Jack Cush, MD

FDA announced yesterday that guselkumab (Tremfya) is approved for use in pediatric patients moderate to severe plaque psoriasis (PsO) or active psoriatic arthritis (PsA) in children six years and older (weighing at least 40 kg).  

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Safety of Combination Targeted Therapies in Psoriatic Arthritis

MedPage Today

Treating psoriatic arthritis (PsA) patients with more than one targeted therapy appears to be just fine, with no increased risk of serious infections, insurance claims data indicate.

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Biologic Switching in Psoriasis

Jack Cush, MD

A systematic review and meta-analysis found that biologic switching was effective in a significant number of psoriasis patients; but there may be a price to pay. 

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Options for Refractory axSpA or PsA

MedPage Today

Although most patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) didn't respond adequately to the interleukin-17 (IL-17) inhibitor ixekizumab (Taltz), enough did that it should still be considered in such cases, a Danish registry study indicated.

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Cancer Survival Outcomes in Autoimmune Skin Disease Patients

Jack Cush, MD

Patients with autoimmune skin diseases (ASDs) with cancer had significantly better cancer survival outcomes than those without ASD, suggesting coexistant autoimmune or inflammatory disease does not adversely affect a cancer prognosis.

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Early DMARD Initiation Benefits in Psoriatic Arthritis

Jack Cush, MD

Mease et al has published the results of a cohort study showing early initiation of disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis (PsA) resulted in better outcomes compared to late initiation.

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ICYMI: Axial Involvement in Psoriatic Arthritis

Jack Cush, MD

Analysis of a Greek Psoriatic Arthritis (PsA) cohort shows that nearly one quarter of patients have axial involvement, and among them, ∼30% have isolated spinal axPsA and nr-axSpA, respectively.

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PCR: Prevalence, Cost, & Risk (6.27.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from last week on RheumNow.com

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What's the latest in PsA? https://t.co/I8ZgRQpVy6 Great review for whats new in PsA by @drpnash Looking forward for Large IL23-Axial study results. @RheumNow #ACR25

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Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)

Heydari-Kamjani et al. TriNetX study. 28973 PsA patients. IL-17i and IL-23i lower rates stroke, MI, DVT/PE than TNFi. IL-12/23i higher rate of stroke vs TNFi. @RheumNow #ACR25 Abstr#2363 https://t.co/fNHaxyYPCP

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Richard Conway RichardPAConway ( View Tweet)
Icotrokinra, the new kid on the bloc! Targeted oral peptide IL-23R-inhibitor Effective in Ph2 and Ph3 in PSO Adults Data in Adolescents (12-18yo) with PSO ICO 200mg QD 44pts vs. PBO 22pts 16wks All pts received ICO wk16-wk24 Clear/Almost clear skin IGA 0/1 84% vs. 24% PASI 90 https://t.co/77YvXtdLi1

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Aurelie Najm AurelieRheumo ( View Tweet)
Effect of BioDMARDs on Diabetes risk in 6400+ Psoriasis pts IL-23i and IL-17Ai associated w/ -lower risks of diabetes -Diabetic nephropathy -Stage 3–5 CKD and reduced risk compared to TNFi treated and bionaive pts Adjustment on several variables, but not disease severity https://t.co/TDIHXJOC2T

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Aurelie Najm AurelieRheumo ( View Tweet)
Guselkumab (Tremfya) 1st IL-23 inhibitor to be FDA approved for subcutaneous induction in adults with ulcerative colitis https://t.co/KaZVzyomeY

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Dr. John Cush RheumNow ( View Tweet)

Biologic survival study of British Assoc. of Dermatologists Biologics Register (11/07-6/23) looked at 19,034 Rx courses (median F/U 2.3 yrs), of TNFi, IL-12/23i, IL-17i, & IL-23i. IL-23i (GUS & RIS) had best survival (~1.93yrs) for efficacy & safety (broadalumab the least) https://t.co/uhomYmiUZy
Dr. John Cush RheumNow ( View Tweet)
GALAXI-2 and GALAXI-3 published showing the efficacy of IL-23 inhibitor, Guselkumab in a 48 week study in adults with moderately to severely active Crohn's disease. https://t.co/pWolec25cX https://t.co/e2fdcMxEro

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Dr. John Cush RheumNow ( View Tweet)
Biologic survival study of British Assoc. of Dermatologists Biologics Register (11/07-6/23) looked at 19,034 Rx courses (median F/U 2.3 yrs), of TNFi, IL-12/23i, IL-17i, & IL-23i. IL-23i (GUS & RIS) had best survival (~1.93yrs) for efficacy & safety (broadalumab the least) https://t.co/aAULb0e3o9
Dr. John Cush RheumNow ( View Tweet)
APEX study showed significant inhibition of structural damage progression with both dosing regimens (Q4W and Q8W) of GUS (IL-23i) in biologic-naïve pts with active PsA. Abstract #LB0010 #EULAR2025 @RheumNow https://t.co/QxYAPGB67v

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Adela Castro AdelaCastro222 ( View Tweet)
In the APEX Phase 3b RCT (N=1020), guselkumab (IL-23p19 inhibitor) significantly reduced radiographic progression (ΔvdH-S 0.55 & 0.54 vs 1.35 PBO; p≤0.002) and improved ACR20 (67–68% vs 47%) at W24 in biologic-naïve PsA. Safety consistent with prior data. Abstract LB0010 https://t.co/mFDsBsCg6m

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
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