IL-23 Inhibitors: The Oral Era Begins

Generated October 2026 · Clinical Deep Dive 0 Comments On March 18, 2026, the FDA cleared icotrokinra (Icotyde), a once-daily oral peptide, for moderate-to-severe plaque psoriasis in patients as young as 12 years old and at least 40 kg who are candidates for systemic therapy or phototherapy.

Icotyde PI It is the first IL-23-pathway drug that does not require an injection. J&J news release The timing is not incidental. Over the same interval, the injectable side of the class has been expanding in the opposite direction: outward, into new organ systems, rather than into new routes of administration.

Guselkumab and risankizumab each now carry four indications spanning dermatology, rheumatology, and gastroenterology; mirikizumab is not approved for any dermatologic indication; and ustekinumab, the class’s decade-old originator, has accumulated eight FDA-approved biosimilars carrying its full indication set.

Stelara PI That divergence, oral simplicity on one axis and indication sprawl on the other, is what makes sequencing across six agents and four diseases harder than a single mechanism diagram suggests. A dermatologist starting first systemic therapy for treatment-naive plaque psoriasis is no longer choosing among five similar injectables; the choice now includes a pill built on a genuinely different trial design.

A gastroenterologist has four agents with inflammatory bowel disease data and needs to know which one still requires an infusion suite for induction. A rheumatologist managing psoriatic arthritis has only three of the six agents with data in that domain at all. This review works through what that expansion now means for choosing among agents in practice.

Agent (Brand) First US Approval Route Indications Now Approved Ustekinumab (Stelara) 2009 Subcutaneous (SC) / intravenous (IV) Plaque psoriasis (PsO) (6y+; candidates for systemic therapy or phototherapy), psoriatic arthritis (PsA) (6y+), moderately to severely active Crohn's disease (2y+), moderately to severely active ulcerative colitis (2y+) Stelara PI Guselkumab (Tremfya) 2017 SC / IV PsO (6y+, ≥40kg; candidates for systemic therapy or phototherapy), PsA (6y+, ≥40kg), moderately to severely active ulcerative colitis (adult), moderately to severely active Crohn's disease (adult) Tremfya PI Tildrakizumab (Ilumya) 2018 SC PsO (adult only; candidates for systemic therapy or phototherapy) Ilumya PI Risankizumab (Skyrizi) 2019 SC / IV PsO (6y+; candidates for systemic therapy or phototherapy), PsA (6y+), moderately to severely active Crohn's disease (adult), moderately to severely active ulcerative colitis (adult) Skyrizi PI Mirikizumab (Omvoh) 2023 IV induction / SC maintenance Moderately to severely active ulcerative colitis (adult), moderately to severely active Crohn's disease (adult); no dermatologic indication Omvoh PI Icotrokinra (Icotyde) 2026 Oral PsO (12y+, ≥40kg; candidates for systemic therapy or phototherapy) Icotyde PI DEEP DIVE Choosing Among the IL-23 Blockers Medscape Medical News © 2026 WebMD, LLC Send comments and news tips to news@medscape.net .

Cite this: Six Agents, Four Diseases, One New Pill: Sequencing Decisions in the IL-23 Inhibitor Class - Medscape - October 19, 2026.