Rheumatology Pitfalls (3.20.2026)
Dr. Jack Cush reviews the regulatory actions, news and journal reports from this past week on RheumNow.com.
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FDA Approves Icotrokinra for Plaque Psoriasis
The FDA approved an oral IL-23 inhibitor, icotrokinra (Icotyde), for use in moderate-to-severe plaque psoriasis in adults and children 12 years of age and older who are candidates for systemic therapy or phototherapy, according to a https://t.co/q5b3TceFHx
Dr. John Cush @RheumNow( View Tweet )
SOLSTICE: phase 3b RCT of IL-23i, guselkumab vs PBO in 451 active PsA pts (GUS q4wk vs q8wk vs PBO). @wk 24 GUS signif better than PBO-ACR20 (59%/62% vs 35%), ACR50 (31%/32% vs 12%), ACR70 (17%/17% vs 2%), PASI 90 (49%/45% vs 12%), MDA (19%/24% vs 5%) ction) https://t.co/QDMCnGdN6J
Dr. John Cush @RheumNow( View Tweet )
FDA Approves Icotrokinra for Plaque Psoriasis
Today the FDA approved an oral IL-23 inhibitor, icotrokinra (Icotyde), for use in moderate-to-severe plaque psoriasis in adults and children 12 years of age and older (who weigh at least 40 kg) who are candidates for systemic therapy or phototherapy.
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FDA has accepted the supplemental biologics license application for use of interleukin-23 inhibitor tildrakizumab (Ilumya; Sun Pharma) in active psoriatic arthritis (PsA) in adults. https://t.co/cwqz9DoWsL https://t.co/fN8pbWtmfT
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Dr. John Cush @RheumNow( View Tweet )
IL-23i fails in GCA? Small RCT of 53 GCA pts (age 71 yrs; 60% new; 40% relapsing GCA) 35 given Guselkumab vs 18 on PBO. Wk 28 GC free remission in 40% vs 33% (P .64), also w/ similar flare rates (31% v 39%). results didnt supportguselkumab use in GCA. https://t.co/AMTmiDBc94 https://t.co/4AQe8HbwQp
Dr. John Cush @RheumNow( View Tweet )
UBER Rheumatology Ride (3.6.2026)
Dr. Jack Cush reviews the news and journal reports from this week on RheumNow.com
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IL-23i fails in GCA? Small RCT of 53 GCA pts (age 71 yrs; 60% new; 40% relapsing GCA) 35 given Guselkumab vs 18 on PBO. Wk 28 GC free remission in 40% vs 33% (P .64), also w/ similar flare rates (31% v 39%). results didnt supportguselkumab use in GCA. https://t.co/AMTmiDBc94 https://t.co/KdWTX9K2Bo
Dr. John Cush @RheumNow( View Tweet )
SATISFACTION (2.27.2026)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.
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Paradoxical Reactions, Target Selection & the Future of Imaging in Psoriatic Care
From paradoxical psoriasis to IL-23 vs IL-17 to imaging in PsA, speakers in RheumNow Live's "Decisions in Psoriatic Arthritis" pod delivered valuable, clinically relevant education.
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RT @gibson_RheumPAC
Axial PsA remains an area of active investigation. IL-17 inhibitors show consistent benefit, while IL-23 data are emerging—highlighting nuances when axial symptoms drive treatment choice. #RNL26 https://t.co/XFL3Sf8iK4
Dr. John Cush @RheumNow( View Tweet )
ANA Pollution (2.06.2026)
Dr. Jack Cush reviews the news, journal articles and regulatory news from this past week on RheumNow.com
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The 2025 Rheumatology Year in Review
The year 2025 presented numerous advances in rheumatology and related inflammatory and autoimmune disorders ranging from several new groundbreaking FDA approvals/indications, drug developments, game-changing guidelines and practices that will impact patient care for rheumatic diseases.
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Advanced Practitioner Biologic Prescriptions for Psoriasis
Advanced practice clinicians (APCs; nurse practitioners and physician assistants) deliver a large share of US dermatologic care, accounting for 37% of clinicians and 27% of dermatology visits by 2020. A current JAMA Dermatology reports APC drug spending trends in dermatology, with a focus on
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APEX Study: Inhibition of structural damage progression with Guselkumab in PsA
Guselkumab, a human IL-23 inhibitor, was evaluated in patients with active PsA and shown to have both clinical and radiographic benefits at weeks 24 and 48.
https://t.co/iNEziysnVZ https://t.co/XgFGFfGf3b
Dr. John Cush @RheumNow( View Tweet )
APEX Study: Inhibition of structural damage progression with Guselkumab in Psoriatic Arthritis
Guselkumab, a human IL-23 inhibitor, was evaluated in patients with active psoriatic arthritis (PsA) and shown to have both clinical and radiographic benefits at weeks 24 and 48.
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IL-23 Blockade Goes Oral
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 IL-23R, is showing encouraging efficacy and safety across a range of psoriasis (PSO) and psoriatic disease (PsD) studies. https://t.co/fYXULrMD16
Dr. John Cush @RheumNow( View Tweet )
IL-23 Blockade Goes Oral
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 https://t.co/7awBk16ZrQ
Dr. John Cush @RheumNow( View Tweet )
ACR 2025 Rheumatology Round Up
Drs. Jack Cush & Arthur Kavanaugh, two of rheumatology’s most trusted voices, provide a breakdown of the latest breakthroughs and hottest topics in rheumatology from the 2025 ACR Convergence meeting in Chicago.
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ACR25 Best Abstracts - Day 4
Here's the last installment of our "ACR Best" abstracts as chosen by the RheumNow faculty. Most of these were from the final, day 4, but a few were noteworthy holdovers from day 3. Enjoy!
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IL-23 Blockade Goes Oral
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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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
Links:
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
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
Links:
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
Links:
Aurelie Najm @AurelieRheumo( View Tweet )
Therapeutic Updates
5-Year Results of an IL-23 Inhibitor in Patients With PsA
Sponsored by AbbVie Medical Affairs + Health Impact
Dr. Alvin Wells and Dr. Shikha Singla share their clinical perspectives on using an IL–23 inhibitor to manage patients with PsA throughout their treatment journey in the context of 5-year data from the KEEPsAKE trial program.
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Recent Blogs
A colleague of mine once told me an interesting story of how her father, who was a doctor, misdiagnosed his wife with fibromyalgia when she actually had psoriatic arthritis with enthesitis all along. I would venture out and say that the average physician would have trouble evaluating enthesitis because even we, as rheumatologists do!
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When balancing all these disease domains, individual phenotypes, and comorbidities, sometimes treatment decisions can feel like tossing a coin. Fortunately, numerous guidelines have been published to help us do better than tossing a coin…or do they?
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With the recent publication of the third iteration of the GRAPPA Psoriatic Arthritis (PsA) treatment recommendations, it seems to be an auspicious time to reflect on some key considerations that arose during the development of the recommendations, as well as to look towards what the future may hold.
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Podcasts
EULAR 2021 - Day2c00:37:25
