Tildrakizumab for the treatment of psoriasis

ABSTRACT

Introduction: Psoriasis is an immune-mediated skin disease amenable to targeted immunotherapy. Tildrakizumab is a humanized IgG1 monoclonal antibody targeting interleukin-23 p19 and is approved for use in moderate to severe psoriasis.

Areas covered: This article reviews the mechanism of action, pharmacokinetics, safety, tolerability, and clinical efficacy of tildrakizumab, administered subcutaneously every 12 weeks, in treatment of moderate to severe psoriasis.

Expert commentary: In two phase 3 clinical trials, tildrakizumab showed a consistent low occurrence of adverse events, underlining safety and tolerance. The long half-life permits subcutaneous injections every 12 weeks. Seventy eight percent of patients achieved PASI 75 (a > 75% improvement from baseline PASI) at 28 weeks, 58% achieved PASI 90, 29% achieved PASI 100 and 70% achieved a Physician’s Global Assessment score of clear or almost clear. A high proportion of patients maintained PASI response after 2 years of treatment. Tildrakizumab improved Dermatology Life Quality Index, psoriasis-related personal relationship problems and sexual difficulties. Baseline PASI score, PGA, and BMI were not predictive of PASI 90 response at week 12, however achievement of PASI 50 by week 8 was predictive of a PASI 90 response at week 12.

KEYWORDS:

• Interleukin-23
• biologicals
• psoriatic arthritis
• nail
• DLQI
• PASI
• PGA

Declaration of interest

R Sinclair has provided professional services to Leo Pharma, Amgen, Novartix, Merck & Co., Inc., Kenilworth, NJ, USA, Celgene, Coherus Biosciences, Janssen, Regeneron, MedImmune, Glaxo Smith Kline, Cutanea, Samson Clinical, Boehringer Ingelheim, Pfizer, MSD, Oncobiologics, Roche, Eli Lilly and Company, and Bayer. 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

A reviewer on this manuscript has disclosed support from Abbvie, Celgene, Janssen, Lilly, Novartis and Sun Pharma. Sun Pharma provided a scientific accuracy review at the request of the journal editor. The peer reviewers have nothing else to declare.

Additional information

Funding

This paper was not funded.