AbbVie’s Skyrizi appears to have stronger efficacy than Johnson & Johnson’s newly approved pill Icotyde, as well as a less frequent dosing schedule that patients could prefer, according to analysts at BMO Capital Markets.
AbbVie is ready to face off against the newest kid on the immunology block: Johnson & Johnson and Protagonist Therapeutics’ peptide pill Icotyde.
The FDA gave the greenlight to Icotyde earlier this month, marking the first oral targeted therapy that blocks the IL-23 receptor and completely clears the skin of patients with plaque psoriasis. This puts the drug’s sponsors in direct competition with immuno stalwart AbbVie, which owns Skyrizi, a biologic therapy that also targets the IL-23 cascade.
First approved in April 2019 for moderate to severe plaque psoriasis, Skyrizi has since become a cornerstone of AbbVie’s portfolio, growing into a $17.562 billion franchise in 2025 to help the pharma gracefully ride out the patent cliff of its mega-blockbuster Humira. The therapeutic antibody has also picked up several other indications, including Crohn’s disease and ulcerative colitis. Skyrizi was the industry’s fifth top-selling drug last year.
“While Icotyde is expected to take share, Skyrizi is likely to remain a value driver for AbbVie across I&I,” analysts at BMO Capital Markets wrote in a note to investors on Friday afternoon after catching up with AbbVie management to clear up competitive concerns following Icotyde’s approval. “AbbVie does not underestimate competitive threats,” the note continued, “but is confident in the strength of Skyrizi.”
Key to AbbVie’s confidence is the drug’s superior efficacy. At 16 weeks in the Phase 3 UltIMMa-1 and UltIMMa-2 studies, 70% to 73% of patients treated with Skyrizi saw a 90% improvement from baseline in Psoriasis Area and Severity Index (PASI) scores, a key tool used to assess disease severity, as compared with placebo. At the same follow-up, 36% to 49% saw a 100% PASI improvement, BMO added, meaning the complete resolution of lesions.
In contrast, Icotyde achieved a 46% placebo-adjusted PASI-90 at 16 weeks in the late-stage ICONIC-LEAD trial, while roughly 27% achieved PASI-100, BMO reported. (In the absence of a direct head-to-head study, cross-trial comparisons are inconclusive.)
Aside from an efficacy edge, Icotyde’s oral availability and daily dosing schedule could also work against it, the analysts continued. “Frequently dosed orals often bring adherence challenges with risk of reduced real-world efficacy,” they explained, noting that skipped doses could lower the drug’s therapeutic benefit. In turn, “providers and patients may favor longer-acting/durable therapies like Skyrizi,” which is administered subcutaneously every three months.
Despite these key advantages for Skyrizi, “we remain positive on the commercial opportunity presented by Icotyde as the first and only oral IL-23 on the market,” BMO stated in its Friday note. J&J and Protagonist are also proposing Icotyde for psoriasis more broadly, an “already large” market that could unlock billions in opportunity for the drug. Peak psoriasis sales for the pill could hit $3.2 billion in 2040, the firm forecasted.
Another plaque psoriasis player is Takeda, though the pharma is far behind AbbVie and J&J, with its TYK2 inhibitor zasocitinib still in Phase 3 development.
Data from a pair of late-stage studies, presented Saturday at the American Academy of Dermatology Annual Meeting, showed that daily doses of zasocitinib induced clear or almost clear skin in 69.2% to 71.4% of patients, as compared with 10.7% to 12.6% of placebo comparators and 29.7% to 32.1% of those on Amgen’s Otezla. PASI-90 was likewise significantly higher in the zasocitinib arms versus placebo and Otezla.
Takeda plans to file for zasocitinib’s approval during its fiscal year 2026, which starts on April 1.
