Tildrakizumab: the value of a personalized and flexible approach for treating moderate-to-severe plaque psoriasis in patients with high body weight or high disease burden

ABSTRACT

Introduction

The introduction of biologics for the treatment of plaque psoriasis is one of the major therapeutic advances of the last decades in dermatology. The efficacy of this class of drugs can be influenced by multiple factors including obesity, being overweight, prior treatment failures, and disease severity.

Areas covered

Most of the currently available approved biologics are limited by their lack of dosing flexibility for adapting the therapy to the complexity of real-world patients with psoriasis. Among the class of anti-interleukin-23, tildrakizumab allows a greater dosing flexibility, increasing clinical benefits of patients with high burden of the disease or body weight >90 kg.

Expert opinion

This meta-opinion discusses the clinical data that were foundational for tildrakizumab dosage flexibility, elaborates on the definition of high burden of disease specifically linked to tildrakizumab dosage, and profiles the ideal patient that could benefit from treatment with the higher approved tildrakizumab dosage of 200 mg.

KEYWORDS:

• Biologics
• body weight
• disease burden
• efficacy
• flexibility
• obesity
• psoriasis
• tildrakizumab

Article highlights

• The efficacy of biologics for the treatment of plaque psoriasis can be influenced by multiple factors including being obese or overweight and disease severity.

• Tildrakizumab allows flexibility at physician’s discretion introducing an additional dosage of 200 mg that may increase clinical benefits of patients with high burden of the disease or body weight >90 kg.

• Challenging populations with psoriasis such as obese patients, patients with a high burden of disease, patients who failed prior therapies with one or more biologics, or patients with a localization of psoriasis in difficult-to-treat areas could potentially benefit from tildrakizumab 200 mg therapy.

• Safety data based on reSURFACE pivotal studies showed a favorable safety profile over 5 years using both tildrakizumab dosages (100 and 200 mg).

Declaration of interest

P Gisondi served as advisory board member and consultant for Amgen, Abbvie, Almirall, Bristol Mayer Squibb, Eli Lilly, Novartis, Jannsen, Pierre Fabre, Sanofi, UCB. P Dapavo served as advisory board member for Eli Lilly, Novartis, Amgen, Abbvie, Leopharma, Bristol, UCB, Janssen, and Almirall. M Burlando served as advisory board member and consultant for Almirall, Janssen, Amgen, Abbvie, Eli Lilly, Novartis, UCB; she has received speaker’s honoraria or has participated in clinical trials for Almirall, Janssen, Amgen, Abbvie, Eli Lilly, Novartis, UCB. C Guarneri served as advisory board member and consultant for Almirall, Abbvie, Amgen, Boheringer-Ingheleim, Ely-Lilly, Janssen, Leopharma, Merck, Novartis, Pfizer, Sanofi and UCB Pharma; he has received speaker’s honoraria or has participated in clinical trials for the same companies. M Megna served as advisory board member and consultant and/or has received speaker’s honoraria or has participated in clinical trials for Eli Lilly, Novartis, Almirall, Leo Pharma, UCB, Janssen, Abbvie, Amgen. Alessandra Narcisi served on advisory boards, received honoraria for lectures and research grants from Almirall, Abbvie, Leo Pharma, Celgene, Eli Lilly, Janssen, Novartis, Sanofi-Genzyme, Amgen and Boehringer Ingelheim. M Talamonti served as advisory board member and consultant for AbbVie, Almirall, Eli Lilly and Company, Janssen, Leo, Novartis, and has received speaker’s honoraria or has participated in clinical trials for AbbVie, Almirall, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Leo, Novartis, Sanofi Genzyme, Sun Pharma, and UCB Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium from Expert Opinion on Biological Therapy for their review work, but have no other relevant financial relationships to disclose.

Additional information

Funding

This paper was funded by Almirall S.p.A., Italy. This funder sponsored the editorial assistance for the writing only, and had no role in content of the manuscript.