With the European Alliance of Associations for Rheumatology’s (EULAR) 2026 meeting less than a month away, physicians, researchers and other healthcare professionals are gearing up for a trip to the UK’s capital, where they will absorb the latest developments in diseases like psoriatic arthritis (PsA).
In recent years, several targeted biologics like AbbVie’s Skyrizi (risankizumab) and Johnson & Johnson’s (J&J) Tremfya (guselkumab) have secured regulatory approval in PsA, offering new options for patients with the disease. However, this patient population still faces significant unmet needs – primarily stemming from the lack of treatment durability and comorbidities like obesity that can impact outcomes.
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As certain needs remain unmet within the immunology space, pharma companies are taking a vested interest in purchasing assets in this disease class. This ballooning interest comes amid the backdrop of blockbuster performance from several immunology assets, with big sellers like Sanofi’s Dupixent (dupilumab) and Skyrizi making billions of dollars across their respective indications.
As the immunology space continues on its upward trajectory, several companies are developing drugs for PsA – some of which experts believe could hold strong uptake potential if they were to secure approval.
Icotyde eyes PsA glory post-psoriasis approval
Fresh off securing the US regulatory greenlight for oral Icotyde (icotrokinra) in plaque psoriasis, Johnson & Johnson (J&J), a co-owner of the drug, is hoping to expand its label to PsA. The oral interleukin-23 (IL-23) pill, which the New Jersey-based pharma developed in tandem with Protagonist Therapeutics, is currently in three late-stage PsA studies.
This includes the ICONIC-PsA 1 (NCT06878404) and ICONIC-PsA 2 (NCT06807424) trials, which are evaluating Icotyde in biologic-naïve and experienced patients, respectively, as well as the ICONIC-ASCEND study (NCT06934226), which is pitting the IL-23 blocker against AbbVie’s rival blockbuster therapy, Stelara (ustekinumab). These three trials have collectively enrolled 2,054 patients across hundreds of global locations.
According to Dr Arthur Kavanaugh, Professor of medicine and rheumatologist at UC San Diego Health, Icotyde will pose as a similarly attractive treatment option in PsA as analysts say it will in psoriasis (PsO). However, he notes that dermatologists treating PsO are generally turning to IL-23 blockers earlier in the treatment paradigm than rheumatologists treating PsA.
Alexis Ogdie, Professor of medicine at the University of Pennsylvania Perelman School of Medicine, adds that Icotyde’s safety profile is good, but the drug appears to be slow-acting – meaning a doctor may not necessarily reach for this therapy to treat patients with highly active disease who want fast symptomatic relief.
While Icotyde could present a new oral option for PsA patients, Ogdie adds that Icotyde is unlikely to be a game-changer in the indication due to the drugs and the wider IL-23 class’s modest efficacy in this indication.
Laura Coates, honorary consultant rheumatologist at Oxford University Hospitals, echoes Ogdie’s sentiments, noting that Icotyde is not more effective than a biologic, and patients on the therapy have to fast every morning, which could be off-putting as longer-acting injectables reach the market.
Despite these factors, Coates believes that Icotyde will see broad uptake in PsA in time.
MoonLake’s sonelokimab seeks slice of PsA market
Another company striving to capture a portion of the PsA market is Swiss biotech, MoonLake Therapeutics, which is developing its high-affinity IL-17A and IL-17F blocker, sonelokimab – a drug that could potentially rival UCB’s Bimzelx (bimekizumab).
This Phase III IZAR-1 trial (NCT06641076) is exploring the potential of the subcutaneous therapy in PsA patients who are naïve to treatment with disease-modifying therapies (DMTs) – with the study set for primary completion in February 2027, as per ClinicalTrials.gov. The IZAR trial has enrolled an estimated 960 patients across 168 global locations.
Unlike Bimzelx, sonelokimab employs a nanobody-based delivery system, which Spyre claims can achieve better tissue penetration than an antibody approach. However, Dr Christopher Ritchlin, Professor of medicine and chief of allergy, immunology and rheumatology at the University of Rochester Medical Center, notes that the company has yet to prove this. “Sonelokimab will likely have a hard time competing with Bimzelx in PsA unless it differentiates itself in terms of efficacy or cost,” he comments.
Coates voices a similar opinion, noting that while sonelokimab’s Phase II readout did meet her expectations for the IL-17 class, the drug will likely be viewed as a “me too” option if it secures approval.
Previously, sonelokimab also failed to best Bimzelx in the skin condition, hidradenitis suppurativa (HS). According to Adeleke Badejo, managing immunology analyst at GlobalData, this HS outcome could result in sonelokimab losing out on absorbing much of Bimzelx’s overall market share across all indications.
Despite these queries, Ogdie notes that sonelokimab was “very strong” in Phase II, and late-stage trials will shed more light on how the drug may compare with existing therapies on the market.
Spyre explores novel mechanism of action
As interleukin blockers increasingly dominate the inflammatory disease segment, Spyre Therapeutics is exploring a new avenue in this disease. Its extended half-life, anti-tumour necrosis factor (TNF)-like cytokine 1A (TL1A) antibody, SPY072, is currently in the Phase II SKYWAY-RD trial (NCT07148414), which is looking at the drug’s potential across rheumatological indications like PsA, axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA).
The PsA sub-study within this trial will pit SPY072 against placebo in patients with moderate-to-severe PsA – all of whom have experienced disease activity despite treatment with standard of care (SoC) non-steroidal anti-inflammatory drugs (NSAIDs) or disease-modifying small molecule or biologic-based therapies. Spyre has enrolled around 285 patients across 57 locations within the wider trial, which the company predicts will reach its primary completion on 31 October 2026.
Unlike drugs currently on the market for PsA, the anti-TL1A class’s benefits are twofold, as the drug may suppress the immune response leading to the disease and prevent fibrotic formation. According to Badejo, the dual effect of these drugs will “likely be more critical in other inflammatory diseases like Crohn’s, but it may still have benefit as fibrosis remains a concern in PsA.”
Badejo adds that if anti-TL1As are shown to be as effective as anti-IL-23 therapies, they should see good adoption by providers, as companies emphasise the anti-fibrotic impacts of these drugs in their campaigns.
Meanwhile, Coates notes that SPY072 and other TL1A inhibitors would give a “truly novel mechanism in rheumatology,” likely positioning the drug as a potential future option for patients who fail treatment with TNF, IL-17 or IL-23 inhibitors.
“The extended half-life and potential for infrequent dosing could also give it an edge, but this depends particularly on whether the drug is proven effective and safe. There are potential safety or immune-related uncertainties with the class, as it influences such a different target, so we need further data to understand more,” Coates says.
Spyre is not alone in its goal to commercialise an anti-TL1A therapy in PsA, as MSD (also known as Merck & Co) is also conducting the Phase II MK-7240-015 study (NCT07486960) of tulisokibart in adults with the condition.
While new drugs are welcomed by physicians, they note that medicines employing new mechanisms of action, as well as therapies that offer long-term disease benefits, will have the most profound impact on the PsA treatment landscape moving forward.
