Effectiveness of Tildrakizumab 200 mg in Moderate-to-Severe Plaque Psoriasis: A Multicenter Real-World Study Analyzing Patient Outcomes by Weight, PASI, BMI, and Previous Therapies.

introductionPsoriasis is a chronic immune-mediated disease with significant systemic implications. Tildrakizumab, an IL-23p19 inhibitor, has demonstrated efficacy in moderate-to-severe plaque psoriasis. Higher doses may be beneficial for patients with elevated body weight or greater disease burden. This study evaluates the effectiveness of tildrakizumab 200 mg in a real-world setting, analyzing outcomes based on weight, Psoriasis Area Severity Index (PASI), body mass index (BMI), and prior biologic exposure.

methodsA multicenter retrospective study was conducted across 10 Italian hospitals. Adult patients (≥ 18 years) with moderate-to-severe plaque psoriasis treated with tildrakizumab 200 mg for ≥ 36 weeks were included. Patients were stratified by weight (≥ 90 kg vs. < 90 kg), BMI (≥ 30 vs. < 30), PASI (≥ 15 vs. < 15), and biologic history (naïve vs. biologic (bio)-experienced). PASI100 response rates at 36 weeks were assessed. Statistical analyses included Fisher's exact test (p < 0.05 significant).

resultsAmong 137 patients, PASI100 response rates were 67.1% for patients < 90 kg vs. 49.2% for ≥ 90 kg (p = 0.04), 61.5% for PASI < 15 vs. 50% for PASI ≥ 15 (p = 0.03), and 60.8% for bio-naïve vs. 57.1% for bio-experienced (p = 0.08). BMI ≥ 30 was associated with lower PASI100 (44.2%) compared to BMI < 30 (61.4%) (p = 0.05). Despite subgroup differences, all patients exhibited clinical improvement.

conclusionTildrakizumab 200 mg effectively treated moderate-to-severe psoriasis across diverse patient subgroups. While higher weight and PASI were associated with slightly lower PASI100 rates, significant improvements were observed, supporting its role in difficult-to-treat patients.