Summary

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• Tildrakizumab-asmn (Ilumya) is indicated for the treatment of adults with moderate-to-severe plaque psoriasis and has demonstrated significant efficacy, notably in achieving PASI 90 scores. It is ranked below high-efficacy treatments such as ixekizumab and risankizumab but offers long-term stability in its efficacy-safety balance.
• A comprehensive review of 15 systematic reviews/meta-analyses was conducted to assess the safety and effectiveness of tildrakizumab compared to other systemic treatments for moderate-to-severe plaque psoriasis.
• In the treatment of nail psoriasis, tildrakizumab has shown promising outcomes similar to other IL-23 inhibitors; however, direct comparisons with IL-17 inhibitors or TNF-alpha inhibitors are limited.
• The safety profile of tildrakizumab is consistent with common adverse events associated with biologic treatments for psoriatic diseases, such as nasopharyngitis and upper respiratory infections. Serious adverse events related to this medication do not significantly differ from placebo effects in most studies.
• Anti-drug antibodies (ADAs) have been observed in patients treated with IL-23 inhibitors including tildrakizumab; however, their clinical significance seems minimal due to a low incidence rate of neutralizing antibodies without any direct correlation reducing its efficacy in psoriasis treatment.
• Subgroup analyses suggest that patients naive to biological treatment or those with varying degrees of baseline disease severity can benefit significantly from using this medication. However, further exploration through comparative studies is necessary, especially when considering patient characteristics such as body weight over 90 kg or conditions like PsA.
• Tildrakizumab's favorable safety profile suggests it could be a valuable stratification tool within personalized medicine, specifically targeting subsets suffering from moderate-to-severe plaque psoriasis without major comorbid PsA conditions.
• Despite the promising results, there is a need for head-to-head trials that extend beyond placebo comparisons to fully integrate indirect comparisons with contemporary biologics and systemic treatments.