Efficacy and Safety of Icotrokinra for Plaque Psoriasis: A Systematic Review and Meta-analysis

In biologic therapies targeting interleukin-23 (IL-23) for plaque psoriasis, parenteral administration can limit treatment adherence and quality of life. Icotrokinra is a first-in-class oral peptide that selectively antagonizes the IL-23 receptor and has shown promising efficacy in phase 2 and phase 3 trials. However, a comprehensive synthesis of efficacy and safety across these trials is currently lacking.

To evaluate the efficacy and safety of Icotrokinra in adolescents (>12 years) and adults (>18) with moderate-to-severe plaque psoriasis.

PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched on December 8th, 2025, with reference lists hand-searched for addition studies. Randomized controlled trials enrolling the target population which compared icotrokinra with placebo and reported efficacy or safety outcomes were included.

Five randomized controlled trials (one phase 2 and four phase 3), comprising 4 reports, met inclusion criteria. Icotrokinra significantly increased the likelihood of achieving IGA 0/1 at week 16 compared with placebo (RR, 7.27; 95% CI, 5.80-9.11), with no heterogeneity (I2=0%). High-level skin clearance, represented by Psoriasis Area and Severity Index 90 was also significantly improved (RR, 13.82; 95% CI, 7.21-26.51). Rates of treatment-emergent and serious adverse events were comparable between icotrokinra and placebo, with no new safety signals identified over the 16-week trial period.

Icotrokinra has shown short-term efficacy and a favorable safety profile in patients with moderate-to-severe plaque psoriasis. Combining biologic-level efficacy with ease of administration, icotrokinra may represent an important advance in psoriasis therapy.