Patient and Physician Perspectives Assess Long-Term Impact of Tildrakizumab for Psoriasis

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Real-life patient assessments on efficacy, safety, and quality of life were evaluated 1 year after beginning treatment for psoriasis with tildrakizumab.¹ Tildrakizumab was proven to be safe and effective for moderate-to-severe disease after the first year, even in areas that are typically difficult to treat. But even with good control of their disease and improved quality of life, some patients remained dissatisfied and were concerned about potential relapse. Tildrakizumab is a high-affinity humanized immunoglobulin antibody which targets the p19 subunit of IL-23. Its clinical efficacy and safety have been tested in randomized trials, reSURFACE 1 and reSURFACE 2.²

The prospective, multicenter study included participants taken from the Observatory of Chronic Inflammatory Skin Diseases (OMCCI) registry. Patients (n = 108) had moderate to severe psoriasis and were being treated with 100 to 200 mg of tildrakizumab via injection. The mean age was 47.2 years with an average disease duration of 20.3 years. More than half of participants (63%) were men. About 40 patients had previously used a biologic and switched to tildrakizumab due to inefficacy.

Evaluations were conducted at baseline/therapy initiation, month 6, and month 12. Patients will be followed for up to 4 years. The Psoriasis Area Severity Index (PASI) assessed disease severity. The patients were also given questionnaires via the Dermatology Life Quality Index (DLQI) and the 12-Item Short-Form Health Survey (SF-12). A Numerical Rating Scale (NRS) ranging from 0 to 10 assessed the impact of psoriasis on patients’ daily life (6.1), family life (4.7), and professional life (4.8). The Individual Burden of Psoriasis (I-Bop) survey was also used.

At baseline, patients were deeply affected by their condition, with 42% showing signs of clinical depression and 34.6% feeling a negative impact on their sex lives, due to the presence of psoriasis on the genitals. The mean PASI score was 13.6, with most patients having a score over 10. SF12-mental component score was 41.5 while the physical dimension score was 50.2. The mean DLQI was 10.4, with nearly half of patients experiencing a “major” or “very high” impact on their quality of life.

At month 6, 93 patients were still utilizing tildrakizumab. This dropped to 75 after 1 year due to lack of efficacy, patient willingness, or other unspecified reasons. No participants ceased treatment for safety reasons. After 6 months, 76% of patients observed improvement in their disease. This increased to 92% after a year.

PASI score decreased to 2.3 after 1 year of follow-up. About 62% of the patients who started tildrakizumab at baseline achieved a PASI 75, 51% had a PASI 90, and 65% reached a PASI score < 3. These improvements were seen even in patients with hard-to-treat regions like the scalp, hands, nails, and genitals.

“The burden of the disease for patients affected on these specific locations is often worse than patients not affected by these types of lesions,” the authors noted.

DLQI dropped to 3.4 after 6 months and 2.5 after 1 year. Over 58% of patients achieved a DLQI 0/1 response after a year. SF-12 mental score improved to 48.7 while the physical score improved to 53.8. Approximately 95% of patients were satisfied with tildrakizumab after 1 year.

Despite these improvements, some patients are still concerned about relapse and the long-term impacts of the disease. After a year of therapy, 80% sometimes feared a relapse or flare, while 52% often had the same fears. This is notable, as the frequency of patients’ anger and frustration is proven to be correlated with disease severity and duration.

The investigators recommend that clinicians conduct a full psychological analysis in patients with psoriasis to identify vulnerable patients who may benefit from additional therapy to improve adherence to treatments like tildrakizumab. Early treatment may also combat the potential mental cicatricial memory that exists in patients over the long term.

“These outcomes and sometimes discrepancies between patients and physicians regarding treatment success and objectives, coupled with the increasing emphasis on shared decision-making in healthcare, underscore the necessity for psoriasis—more specific tools aiming to facilitate communication between patients and physicians and to provide a better understanding of patient treatment expectations,” the authors concluded.

References

1. Reguiai Z, Becherel PA, Perrot JL, et al. Patient’s perspective on the impact of psoriasis on their quality of life after 1 year of tildrakizumab treatment: Despite clinical improvement, persistence of a potential mental cicatricial memory of the disease. JEADV Clinical Practice. Published online March 19, 2025. doi:10.1002/jvc2.70021

2. Reich K, Papp KA, Blauvelt A, et al. Tildrakizumab versus placebo or etanercept for chronic plaque psoriasis (reSURFACE 1 and reSURFACE 2): results from two randomised controlled, phase 3 trials [published correction appears in Lancet. 2017 Jul 15;390(10091):230. doi: 10.1016/S0140-6736(17)31834-2.]. Lancet. 2017;390(10091):276-288. doi:10.1016/S0140-6736(17)31279-5