At the 2025 American Academy of Dermatology Annual Meeting, Dr. Bruce E. Strober, MD, PhD, FAAD, a clinical professor of dermatology at Yale University School of Medicine, delivered a compelling presentation outlining transformative advancements in psoriasis treatment. These developments promise to improve patient outcomes and revolutionize clinical approaches. Dr. Strober highlighted innovations across oral therapies, biologics, and a reimagined framework for understanding psoriasis severity, offering a comprehensive vision for the future of care.
Emerging Oral Therapies
Central to his talk was the emergence of new oral therapies, including thrombopoietin receptor agonist (TRO-RA), a novel IL-23 receptor antagonist. Dr. Strober highlighted recent phase 3 data from an early clinical trial suggests TRO-RA’s potential.
"The data are roughly the same as the phase two, except it appears with the two daily dose is a slower response," he said in his presentation. "Not surprisingly, IL-23 inhibition is a mechanism of action that requires a bit more time for the therapeutic to reach its maximum response. So from this study, two out of three patients are going to get to positive 90 by week 24 and maybe even more after that."
Dr. Strober also discussed the arrival of TYK2 inhibitors such as deucravacitinib, emphasizing their improved selectivity and minimal need for laboratory monitoring. He also noted that other TYK2 inhibitors, including zasocitinib, are in various stages of the research pipeline.
"There are at least two others in the pipeline that purport to be improvements over deucravacitinib on basically on two fronts," he noted. "They're more avidly binding to the target, more selective of that target as well, and therefore might achieve higher efficacy. There's a hint of that in this phase two study of zasocitinib, given that multiple doses beats a placebo."
Dr. Strober added that given current phase 2 data, which showed zasocitinib at higher doses (15 mg and 30 mg) achieving PASI 90 in 2/3 of patients at week 12 (deucravacitinib achieved PASI 90 in 2/3 of patients at week 16 and week 24), means that the drug would likely need to improve efficacy to match that of the oral peptides.
"Week 12 is an early timepoint, so maybe week 24 for this drug is even better," he added. "We'll see where phase three takes us."
He also noted that the current approved TYK2 inhibitors aren't associated with laboratory abnormalities.
Biologic Breakthroughs
Dr. Strober also spent time highlighting biologics that address both psoriasis and related complications, such as psoriatic arthritis (PsA). Recent studies Dr. Stober cited suggested IL-23 inhibitors may be effective in preventing arthritis onset, a discovery he said that could reshape treatment strategies and encourage earlier intervention.
"The question is, does the treatment of psoriasis in a person who does not have PSA forestall the presentation of future psoriatic arthritis in that person?" he said. "Can we prevent PSA by treating psoriasis with certain classes of our biologic therapies? "
Additionally, advancements in monoclonal antibody recycling have extended the half-life of biologic therapies, enabling longer dosing intervals. These developments could allow for dosing every six to twelve months, enhancing convenience and adherence for patients while maintaining efficacy.
Addressing Comorbidities
Beyond skin clearance, Dr. Strober emphasized the need to address psoriasis-related comorbidities. He highlighted data showing that long-term use of apremilast can improve metabolic markers, such as BMI and lipid profiles, suggesting its value as an add-on therapy for high-risk patients. This focus on holistic care reflects a growing understanding of psoriasis as a systemic condition requiring comprehensive management strategies.
"The people most at risk who stay on apremilast for three years have the best chance of improving on those individual parameters [such as LDL cholesterol, hemoglobin A1c, body mass index (BMI)]," he said. "If you're asking if they have to do well with regard to the psoriasis response, the answer is no. So what does this mean? It means to me that apremilast as a psoriasis therapy might be a great benefit to people at high risk who are overweight, have high BMI, poorly managed diabetes, dyslipidemia, and maybe a combination [of these comorbidities]. They might be the best responders on those parameters over time."
Rethinking Psoriasis Severity
A portion of Dr. Strober’s presentation centered on reclassifying psoriasis severity to better serve patients with high-impact, low-body surface area (BSA) cases. He advocated for recognizing the effects of psoriasis in challenging areas such as the scalp, palms, and nails, regardless of total BSA involvement. Data from recent studies, he noted, show that patients with low-BSA psoriasis respond as well to systemic treatments as those with more extensive disease, underscoring the need for equitable treatment access.
"Adhering to either BSA or PASI alone often leads under treatment," Dr. Strober said. "High-impact areas elevate the treatment necessity. There are a lot of data suggest just having high impact areas elevates."
The Future of Psoriasis Care
Dr. Strober concluded by envisioning a future of more personalized and effective psoriasis care. He emphasized the importance of early intervention, integration of oral and biologic therapies, and a sustained focus on addressing comorbidities.
“The integration of these innovations will allow us to address not just the skin but also the broader health and quality-of-life challenges faced by psoriasis patients,” he said, signaling a transformative shift in dermatologic care.
This comprehensive approach, combining scientific breakthroughs with patient-centered care, positions psoriasis therapy at the forefront of medical innovation, offering hope and improved quality of life for millions worldwide. -by Eric Raible
Source: Strober BE. Update on Therapies for Psoriasis: Current and Pipeline. Session S047. Presented at: 2025 American Academy of Dermatology Annual Meeting, March7-11; Orlando.