Important Emerging Oral Therapies, Guidelines to Be Highlighted at AAD 2026: James Song, MD

Ahead of the 2026 American Academy of Dermatology (AAD) Annual Meeting, James Song, MD, chief medical officer and director of clinical research, Frontier Dermatology, outlines major advances in systemic therapies for psoriasis, atopic dermatitis, and chronic spontaneous urticaria (CSU), with a focus on how new agents may change everyday clinical practice.

Emerging systemic therapies are poised to reshape treatment strategies, with several late-stage agents offering biologic-level efficacy in more convenient formats.

For psoriasis, clinicians may soon have access to the first highly effective oral therapy approaching the performance of established biologics. This agent, icotrokinra, is an oral peptide targeting the IL-23 receptor with high selectivity and affinity. Data from 52-week studies in high-impact sites and 24-week, head-to-head trials vs deucravacitinib show very high levels of skin clearance, comparable to leading biologic agents. Notably, its safety profile appears similar to placebo, an unusual and compelling feature for a systemic treatment. If confirmed in broader clinical use, this could fill a long-standing gap between topical therapies and injectable biologics, especially for patients seeking effective, convenient oral options.

Two additional oral agents—the second-generation tyrosine kinase 2 (TYK2) inhibitors envudeucitinib and zasocitinib—aim to improve on the first-in-class agent deucravacitinib. Like their predecessor, they bind the allosteric JH2 domain of TYK2 but with greater affinity and selectivity, which appears to translate into more rapid onset and deeper responses in early data. Expanded phase 3 results are anticipated at upcoming AAD meetings, although regulatory approvals are not expected until at least next year.

In atopic dermatitis, an extended-interval IL-13 inhibitor, zumilokibart, could further reduce treatment burden. Building on the mechanism and epitope targeting of lebrikizumab, this agent is being developed for dosing every 3 to 6 months following an induction period, with the goal of maintaining high efficacy while minimizing injection frequency.

The landscape of OX40 and OX40 ligand blockade in AD remains active but nuanced. Development of the OX40 inhibitor rocatinlimab has been discontinued after emerging safety data failed to justify further advancement. However, another OX40 ligand–targeting agent continues through clinical development, with additional results pending.

Finally, newly released CSU treatment guidelines—developed with participation from AAD—provide updated, structured guidance on evaluating multiple recently approved agents. These recommendations are expected to help clinicians more precisely balance efficacy, safety, and long-term risk–benefit in a rapidly evolving therapeutic landscape.