Real-World Study of Tildrakizumab Survival in Psoriasis: Impact of Arthritis, Hypertension, and Prior Biologic Use

Abstract

In routine clinical settings, identifying the factors that influence the persistence of biologic therapies is crucial for tailoring psoriasis management to individual patient profiles. This study aimed to evaluate the real-world drug survival of tildrakizumab in patients diagnosed with plaque psoriasis at the Dermatology Department of HUCA and to explore the clinical predictors of treatment discontinuation. We conducted a retrospective, hospital-based analysis involving 100 patients treated with tildrakizumab (Ilumetri^®) between 1 January 2021 and 30 April 2024. Kaplan-Meier estimates were used to construct survival curves, and multivariate analyses were performed using Cox proportional hazards regression models. Both crude and adjusted hazard ratios (HRs) were calculated to assess potential differences across patient subgroups. The multivariate analysis identified statistically significant associations between reduced drug survival and the presence of psoriatic arthritis (p = 0.02), previous biologic exposure (p = 0.02), and arterial hypertension (p = 0.012). Other comorbidities did not demonstrate significant effects. The most common reasons for treatment discontinuation were primary inefficacy and suboptimal response in patients with arthritis. Overall, tildrakizumab demonstrated robust survival outcomes in this patient population, though diminished persistence was observed in those with prior biologic use, comorbid arthritis, and hypertension.

Keywords: Anti-IL23; real world; tildrakizumab.

Figure 1

(A) Kaplan–Meier curve of tildrakizumab survival. (B) Kaplan–Meier curves of tildrakizumab survival according to arthritis (p < 0.001). (C) Kaplan–Meier curves of tildrakizumab survival according to arterial hypertension (p < 0.001). (D) Kaplan–Meier curves of tildrakizumab according to dyslipidemia (p < 0.028) (E) Kaplan–Meier curves of tildrakizumab survival according to previous biological treatments (p < 0.001).