Real-World Effectiveness and Safety of Tildrakizumab in Patients With Moderate-to-Severe Psoriasis After Failure of Ustekinumab: A Multicenter Retrospective Study.

Abstract

Objective: To evaluate the effectiveness and safety of switching to tildrakizumab, a selective interleukin (IL) 23p19 inhibitor, in patients with moderate-to-severe plaque psoriasis who had an inadequate response to ustekinumab (IL-12/23 inhibitor) in a real-world setting.

Methods: A multicenter retrospective observational study was conducted and included 14 patients who switched to tildrakizumab following ustekinumab failure. Effectiveness was assessed using Psoriasis Area and Severity Index (PASI), Physician Global Assessment (PGA), and Dermatology Life Quality Index (DLQI) at Weeks 0, 12, 28, 36, and 52.

Results: The cohort (mean age: 45.92 years; 85.7% prior systemic therapy) showed rapid improvement. Mean PASI decreased from 9.36 at baseline to 2.60 at Week 12, maintaining low disease activity through Week 52 with 100% of patients achieving an absolute PASI score <3. Similar trends were observed in PGA and DLQI scores. No new safety signals were identified.

Limitations: This study included a small sample size (n=14) and retrospective design.

Conclusion: Tildrakizumab showed consistent clinical improvement as a rescue therapy for patients after ustekinumab failure, supporting the clinical benefit of switching from p40 to specific p19 inhibition.