Several classes of new oral therapy are in use or in development for the 
treatment of psoriasis. Despite the high efficacy of biologics, new oral 
therapies remain important as patients generally prefer this mode of 
administration and they offer an alternative risk-benefit profile. In this 
review, we discuss the novel modes of action of these drugs, including 
modulation of cellular pathways involving diverse targets such as Janus kinase, 
phosphodiesterase 4, sphingosine 1-phosphate, A3 adenosine receptor and 
rho-associated kinase 2. We review the available evidence around licensed drugs 
(apremilast) and drugs that are advanced (tofacitinib) or early (ponesimod, 
baricitinib, peficitinib, INCB039110, CF101, KD025) in the development pipeline. 
The key limitations of these oral therapies are their modest efficacy profile 
(apremilast, ponesimod) and the limitations of their safety profile 
(tofacitinib, ponesimod), while the evidence for the early pipeline drugs are at 
phase II level only. Potential niches of current unmet needs include apremilast 
for patients with concomitant psoriatic arthritis, as combination treatments 
with biologic therapies, and/or for patients in whom multiple biologic therapies 
have failed due to immunogenicity and secondary inefficacy. The present 
knowledge gap regarding these novel drugs includes the need for longer clinical 
trials or observational studies to evaluate safety, and randomised phase III 
trials for the early pipeline drugs. We conclude that further research and data 
are necessary to conclusively establish the role of these agents in the current 
psoriasis treatment paradigm.