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. 2025 Jul;15(7):1941-1952.
doi: 10.1007/s13555-025-01442-x. Epub 2025 May 24.

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

Emanuele Trovato  1 , Tommaso Bianchelli  2 , Giulia Odorici  3 , Aldo Cuccia  4 , Vito Giuseppe Di Lernia  5 , Claudia Lasagni  6 , Marco Manfredini  6 , Massimiliano Nicolini  7 , Giulia Rech  8 , Francesca Satolli  9 , Alessandra Cartocci  10 , Federico Bardazzi  11 , Anna Campanati  12
Affiliations

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

Emanuele Trovato et al. Dermatol Ther (Heidelb). 2025 Jul.

Abstract

Introduction: Psoriasis 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.

Methods: A 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).

Results: Among 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.

Conclusion: Tildrakizumab 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.

Keywords: Biologics; Body mass index; Pasi; Psoriasis; Tildrakizumab; Weight.

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Conflict of interest statement

Declarations. Conflict of Interest: Anna Campanati is an Editorial Board member of Dermatology and Therapy. Anna Campanati was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Emanuele Trovato has nothing to disclose. Tommaso Bianchelli has nothing to disclose. Giulia Odorici has nothing to disclose. Aldo Cuccia has nothing to disclose. Vito Giuseppe Di Lernia has nothing to disclose. Claudia Lasagni has nothing to disclose. Marco Manfredini has nothing to disclose. Massimiliano Nicolini has nothing to disclose. Giulia Rech has nothing to disclose. Francesca Satolli has nothing to disclose. Alessandra Cartocci has nothing to disclose. Federico Bardazzi has nothing to disclose. Ethical Approval: The study was conducted in accordance with the Declaration of Helsinki (1964 and subsequent amendments) and it was approved by the local ethics committee (N° 22045).

Figures

Fig. 1
Fig. 1
Percentages of patients achieving Psoriasis Area Severity Index (PASI)-90 and PASI100 responses at different time points (week 4, week 16, and week 36) across the study population (a) and in patients with both high PASI and high weight (b). The overall percentages of patients achieving PASI90 and PASI100 shows a steady increase is observed over time, with higher percentages for PASI90 compared to PASI100 at all time points. The group with both high weight and high PASI shows improvement over time, though response rates for PASI90 and PASI100 are lower compared to other subgroups, indicating a potential challenge in achieving optimal responses in this population
Fig. 2
Fig. 2
a Weight-based stratification: both groups exhibit increasing Psoriasis Area Severity Index (PASI)-90 and PASI100 responses over time, with the < 90 kg group showing slightly higher response rates, particularly for PASI100. b PASI-based stratification: patients with baseline PASI ≥ 15 show higher PASI90 and PASI100 responses, reflecting a greater relative improvement in those with more severe disease at baseline. c Body mass index (BMI)-based stratification: the BMI < 30 group demonstrates consistently higher PASI90 and PASI100 responses compared to the BMI ≥ 30 group, suggesting better outcomes in patients with lower BMI. d Treatment history stratification: naïve patients achieve notably higher PASI90 and PASI100 responses compared to biologic-experienced patients, particularly at week 16 and week 36
Fig. 3
Fig. 3
Progression of mean Psoriasis Area Severity Index (PASI) scores from baseline to week 36 across different patient subgroups, stratified by weight, baseline PASI, body mass index (BMI), and treatment history. All groups show a substantial reduction over time, reflecting overall treatment effectiveness
Fig. 4
Fig. 4
Box plots showing the distribution of mean Psoriasis Area Severity Index (PASI) scores at baseline, week 4, week 16, and week 36 across patient subgroups stratified by weight (a), baseline PASI (b), body mass index (BMI) (c), and prior biologic treatment (d). All subgroups exhibit a consistent reduction in PASI scores over time
Fig. 5
Fig. 5
Box plots of mean Psoriasis Area Severity Index (PASI) scores at each time point for patients with both high baseline PASI and high body weight, illustrating substantial and sustained improvement despite higher disease severity at baseline
See this image and copyright information in PMC

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