Work

Real-World Benefit of Tildrakizumab for Moderate-to-Severe Plaque Psoriasis: Findings from a Systematic Literature Review and Meta-Analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Plaque psoriasis (PsO) is an inflammatory skin disease that can impair quality of life. Tildrakizumab, an anti-IL-23 p19 monoclonal antibody, offers a treatment option for patients eligible for systemic therapy or phototherapy, but real-world results have not been comprehensively analyzed. This systematic review and meta-analysis evaluated real-world effectiveness, quality-of-life impact, and safety of tildrakizumab for treatment of moderate-to-severe plaque PsO, alone and relative to guselkumab and risankizumab. MEDLINE® and Embase were searched on November 16, 2023, along with meeting abstracts (2021–2023) and bibliographies of previous reviews, for English-language real-world studies of tildrakizumab (singly or comparative) in adults with chronic moderate-to-severe plaque PsO. Outcomes included effectiveness (Psoriasis Area and Severity Index [PASI], Physician’s Global Assessment [PGA], body surface area percentage [%BSA] affected), Dermatology Life Quality Index (DLQI), and safety (adverse events [AEs], serious AEs [SAEs], treatment-related AEs [TRAEs], or withdrawals due to AEs [WDAEs]). Meta-analyses were performed at 12–16, 24–28, and 36–52 weeks. Of 6982 records screened, 37 studies (45 publications) were analyzed. Tildrakizumab-treated patients experienced 78–87% improvement from baseline to 36–52 weeks across mean absolute PASI (12.81 [95% confidence interval 11.69, 13.92] to 1.62 [1.03, 2.20]), %BSA (16.21% [13.72%, 18.70%] to 3.27% [1.26%, 5.28%]), PGA (3.18 [2.89, 3.47] to 0.70 [0.08, 1.33]), and DLQI (14.59 [12.32, 16.87] to 1.83 [0.84, 2.82]), with low rates of AEs, SAEs, TRAEs, and WDAEs. Benefits and safety of tildrakizumab were similar to guselkumab and risankizumab. Tildrakizumab demonstrated effectiveness, with reduction from moderate-to-severe to mild disease and improved DLQI scores, without notable safety concerns, for up to 1 year in this real-world meta-analysis. Although real-world data must be interpreted cautiously because of heterogeneity and potential bias, these findings align with randomized trial results, further supporting the use of tildrakizumab in clinical practice. Plaque psoriasis is a chronic skin condition with several treatment options, including tildrakizumab, an antibody approved to treat moderate-to-severe plaque psoriasis in adults. The efficacy and safety of tildrakizumab were first established in clinical trials, but because clinical trials are conducted under ideal conditions, results in real-world practice may be different. This study reviewed and analyzed results from published studies outside of clinical trial settings. These real-world studies provide insight into how tildrakizumab works in everyday clinical practice. The findings from this study showed that tildrakizumab treatment is associated with continued effectiveness over time, improvements in skin-related quality of life, and no new or unexpected safety concerns in patients with moderate-to-severe plaque psoriasis.

Source: Dermatology and Therapy

DOI: 10.1007/s13555-025-01625-6