A Retrospective Real-World Study of the Effectiveness and Tolerability of Tildrakizumab in UK Adults with Moderate-to-Severe Chronic Plaque Psoriasis

Abstract

Introduction: As with most medicines historically, clinicians prescribing tildrakizumab have relied on information derived from registration studies undertaken in a prospective controlled clinical trial setting. More recently, clinicians, policymakers, and commissioners increasingly rely on real-world data to inform both policy and practice.

Methods: A retrospective real-world data study was undertaken at four specialist dermatology departments in the United Kingdom. All adult patients treated with tildrakizumab for moderate-to-severe plaque psoriasis were included, with data being collected for 122 patients.

Results: Psoriatic patients on tildrakizumab tended to be overweight (median body mass index of 32 (range 19-59) (n = 61); 26/68 (38%) < 90 kg, 32/68 (47%) between 90 and 120 kg, and 10/68 (15%) > 120 kg). The study population had high levels of comorbidities (83/116, 72%), multiple special sites (39/117, 33%), and histories of biological treatments (81/100, 81%). Most patients (61/80, 76%) initiated on tildrakizumab were switched from another biological treatment. Tildrakizumab was effective, with 91/122 (75%) patients remaining on treatment for the duration of the study-a median of 12 months per patient (range 1-29 months)-and achieving a change in median Psoriasis Area and Severity Index (PASI) from 12 to 0.35 and in Dermatology Life Quality Index (DLQI) from 20 to 0. The response rate was 57/66 (86%) when tildrakizumab was used as the first- or second-line biologic compared to 19/31 (61%) when used as the third- to seventh-line. Thirty-three (78.6%) patients over 90 kg of weight received the 200-mg dose of tildrakizumab. All but one (n = 8) patient with body weight over 120 kg maintained response over time. There was one treatment discontinuation; a patient who had a local sensitivity reaction.

Conclusions: In UK clinical practice, tildrakizumab was well tolerated and effective at doses of 100 mg or 200 mg in a range of patient phenotypes.

Keywords: Plaque psoriasis; Real world; Tildrakizumab.

Fig. 1

Response to tildrakizumab. Response was described as primary failure (‘No Response’) if the psoriasis did not respond adequately to tildrakizumab, and as secondary failure (‘Partial Response’) if the psoriasis initially responded adequately but the response was subsequently lost

Fig. 2

Variation between study sites in persistence with tildrakizumab. The Kaplan–Meier survival curve is a statistical model used here to predict the length of time patients remain on tildrakizumab. The curve shows the cumulative risk of a patient discontinuing treatment; the risk is recalculated at each timepoint a patient discontinues treatment and uses, as the denominator, the patients remaining at risk of discontinuation

Fig. 3

Change in average PASI score over time for the cohort of patients receiving tildrakizumab. The solid line is the trend, which is exponential and weighted by the number of results. The broken line is the 95% simultaneous confidence band

Fig. 4

Effect plot for the number of previous biologic treatments from the final logistic model. The number of previous biological treatments in the multivariate logistic regression model predicts that with every single additional treatment, the probability of the response to tildrakizumab (% responders) decreases by 40%

Fig. 5

Doses of tildrakizumab by patient body weight category