As newer medications are being developed with different therapeutic targets, safety profiles, and efficacy profiles, the potential role of oral therapies in the management of plaque psoriasis is being reconsidered. New data on several oral therapies were presented at the recent Maui Derm Hawaii 2026 meeting, and the role of newer targeted oral therapies vs injectable biologic therapies was also discussed.

Following these presentations, featured expert Jason Ezra Hawkes, MD, MS, FAAD, was interviewed by Conference Reporter Associate Editor-in-Chief Rick Davis, MS, RPh. Clinical perspectives from Dr Hawkes on these findings are presented here.

We are beginning to close the gap between oral and biologic therapies for the treatment of plaque psoriasis. Historically, the choice of an oral therapy came with the drawback(s) of potential side effects and/or reduced efficacy. However, patients may soon be able to choose an oral therapy with biologic-like efficacy and a safety profile that mimics the safety that we frequently associate with targeted biologic therapies. This would make the choice between oral and biologic therapies a little more balanced, as they would be more comparable when patients are choosing between therapies.

The matching-adjusted indirect comparison of icotrokinra vs risankizumab in adults with moderate to severe plaque psoriasis by Jeffrey J. Crowley, MD, MS, and colleagues presented at Maui Derm Hawaii 2026 is trying to answer a key question that both patients and clinicians are going to have. We need to know how good novel oral agents such as icotrokinra really are compared with established biologic agents such as risankizumab or guselkumab.

The poster reported that more rapid Psoriasis Area and Severity Index (PASI) improvement was seen with risankizumab than with icotrokinra until week 24, at which point response rates for skin clearance and disease severity outcomes between the 2 drugs became more similar. This outcome is not surprising to me, and it may be due to multiple reasons, including lower adherence associated with taking a pill every day vs having an injection once every 3 months. Also, oral agents must go through the gastrointestinal tract for absorption and first-pass metabolism, which biologics do not. The ability to achieve higher, more stable doses of medication is likely going to be superior with biologic therapies.

One limitation of the study by Dr Crowley et al is that the primary end point was at week 16, and this time point may not provide a fair comparison between the 2 therapies from the patient’s perspective. For the patient who has had plaque psoriasis for many years, 16 weeks may not be a time point that is critical to them if their success in achieving clearer skin continues to improve beyond 16 weeks. The research question with these oral therapies now needs to be: What happens to that same patient at 6, 9, and 12 months? We need to determine the point at which the highest proportion of patients on oral therapy achieves the best clearance and then compare that with the peak for biologic therapies, because speed is only 1 isolated characteristic that our patients need to consider. I think that these long-term studies are going to be important for patients who may be willing to wait a little bit longer if they know that they are going to achieve a certain level of skin clearance.

The poster by Jennifer Soung, MD, and colleagues from this year’s Maui Derm Hawaii meeting points out that the oral peptide IL-23R inhibitor icotrokinra appears to have a safety profile that is comparable to some of the injectable IL-23 inhibitors. They found that when you look at daily oral icotrokinra as an IL-23R inhibitor, you may see an efficacy that mimics that of an anti–IL-17A biologic, with high PASI 90 rates in this study of adolescents and adults of around 85% through week 52. This really closes the gap between the oral and biologic agents for plaque psoriasis and leaves patients with improved medication options that may better align with their individual treatment preferences.

In posters by April W. Armstrong, MD, MPH, et al and Nada M. Elbuluk, MD, MSc, and colleagues presented at Maui Derm Hawaii 2026, the oral selective TYK2 inhibitors envudeucitinib and zasocitinib, respectively, showed good efficacy in patients with moderate to severe plaque psoriasis. However, the real question for providers and patients is going to be: What is the long-term safety for these agents? While the inhibition of TYK2 interferes with IL-23’s ability to drive the production of IL-17 cytokines in Th17 cells, the benefits of blocking IL-12 and type I interferons are much less clear and may potentially have drawbacks such as viral reactivation and acne-like eruptions.

When you offer an oral option to patients, it is very interesting to see how many would opt for an oral therapy over an injectable therapy when they do not compromise much on efficacy and safety. When asked, many patients have the perception that oral therapies may be safer or at least feel less invasive than an injection. Additionally, a subset of patients may prefer an oral therapy because it is easy for them to incorporate another pill into their daily medications for other conditions such as hypertension or hyperlipidemia. For the first time in this field of study, we are going to see what true shared decision making looks like because patients with plaque psoriasis will have both oral and biologic options that they can feel good about choosing without compromising efficacy and safety.