Effectiveness of Tildrakizumab in the Long-Term Treatment of Plaque Psoriasis: A Retrospective, Multicenter Analysis Over 76 Weeks

Abstract

Background: Psoriasis is a chronic inflammatory disease affecting skin and patients’ quality of life. Tildrakizumab is an IL-23p19-inhibitor approved for treatment of moderate-to-severe plaque psoriasis. Objective: To evaluate the effectiveness of tildrakizumab in daily practice in a heterogeneous cohort of patients with psoriasis often accompanied by comorbid (especially cardiometabolic) diseases. Methods: We conducted a retrospective analysis at two university outpatient clinics in Germany (April 2018 to June 2024), collecting data on patient characteristics, comorbidities, prior therapies, and treatment response. Results: The effectiveness analysis included 111 patients with psoriasis treated with tildrakizumab. Median PASI was 12.6 (IQR 11.0–18.6) at baseline and decreased to 6.0 (IQR 1.0–10.4) at Week 4, to 1.8 (IQR 1.0–10.4) at Week 16, and median PASI 0.00 (IQR 0.0–0.0) at Week 76. Median PASI < 3 was achieved by 64.6% at Week 16, 79.7% at Week 52 and 94.4% at Week 76 and PASI < 5 by 83.3% at Week 16, 94.2% at Week 52, and 100% at Week 76. The proportion achieving PASI75, PASI90, and PASI100 at Week 76 was 97.2%, 83.3%, and 58.3%. Patients with arterial hypertension (AHT) showed a lower PASI response compared to those without AHT, starting from Week 28 (p = 0.035) and continuing throughout the follow-up period. However, a detailed analysis indicates that patients with AHT also achieved PASI < 3 at Week 28 and beyond. Furthermore, patients with at least one cardiovascular risk factor (CRF: obesity, dyslipidemia, AHT, or type 2 diabetes mellitus, [46.8%]) demonstrated a less pronounced PASI response at Weeks 16, 28, and 64 compared to patients without such risk factors (pwk16 = 0.023; pwk28 = 0.012; pwk64 = 0.014). Median DLQI at baseline was 16.0 (IQR 9.5–22.0) and improved to 3.0 (IQR 1.0–8.0) at 4–16 weeks. Conclusion: This analysis confirmed effectiveness of tildrakizumab in a real-world setting, with notable improvements in PASI response observed in a heterogeneous patient cohort and a high level of quality of life improvement. It is noteworthy that patients with AHT and other CRF demonstrated lower treatment responses, indicating that these comorbidities may exert an influence on outcomes.