Advertisement

Update on Tildrakizumab for Psoriasis

  • Abdul R. AnsariEmail author
  • Arjun M. Bashyam
  • Steven R. Feldman
Psoriasis (J Wu, Section Editor)
  • 3 Downloads
Part of the following topical collections:
  1. Topical Collection on Psoriasis

Abstract

Purpose of Review

Tildrakizumab, a humanized IgG1κ monoclonal antibody that inhibits the p19 subunit of interleukin (IL-)23, is FDA approved for the treatment of moderate-to-severe plaque psoriasis. This article will review recent publications on tildrakizumab to evaluate its pharmacokinetics, efficacy, and safety.

Recent Findings

Tildrakizumab maintains efficacy in moderate-to-severe plaque psoriasis for up to 3 years with low risk of adverse events.

Summary

IL-23p19 inhibition with tildrakizumab is a useful therapy for treating moderate-to-severe psoriasis. It is superior to placebo and etanercept in clinical trials as measured by Psoriasis Area Severity Index (PASI), Physician Global Assessment (PGA), and Dermatology Life Quality Index (DLQI) scores. Clinical improvements are maintained for up to 3 years. It has a low frequency of adverse events that is similar to placebo, with the most common being headache and nasopharyngitis. Tildrakizumab can be a useful therapeutic option for patients with plaque psoriasis resistant to phototherapy and other systemic medications.

Keywords

Tildrakizumab Ilumya IL23p19 Efficacy Safety Long term 

Notes

Compliance with Ethical Standards

Conflict of Interest

Steven Feldman has received research, speaking, and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and National Psoriasis Foundation. He is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment.

Abdul Ansari and Arjun Bashyam have no conflicts to disclose.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Hawkes JE, Chan TC, Krueger JG. Psoriasis pathogenesis and the development of novel targeted immune therapies. J Allergy Clin Immunol. 2017;140(3):645–53.  https://doi.org/10.1016/j.jaci.2017.07.004.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Mrowietz U, Kragballe K, Reich K, Spuls P, Griffiths CEM, Nast A, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res. 2011;303(1):1–10.  https://doi.org/10.1007/s00403-010-1080-1.CrossRefPubMedGoogle Scholar
  3. 3.
    Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029–72.  https://doi.org/10.1016/j.jaad.2018.11.057.CrossRefPubMedGoogle Scholar
  4. 4.
    Elder JT, Bruce AT, Gudjonsson JE, Johnston A, Stuart PE, Tejasvi T, et al. Molecular dissection of psoriasis: integrating genetics and biology. J Invest Dermatol. 2010;130(5):1213–26.  https://doi.org/10.1038/jid.2009.319.CrossRefPubMedGoogle Scholar
  5. 5.
    Kopp T, Riedl E, Bangert C, Bowman EP, Greisenegger E, Horowitz A, et al. Clinical improvement in psoriasis with specific targeting of interleukin-23. Nature. 2015;521(7551):222–6.  https://doi.org/10.1038/nature14175.CrossRefPubMedGoogle Scholar
  6. 6.
    Jauslin P, Kulkarni P, Li H, Vatakuti S, Hussain A, Wenning L, et al. Population-pharmacokinetic modeling of tildrakizumab (MK-3222), an anti-interleukin-23-p19 monoclonal antibody, in healthy volunteers and subjects with psoriasis. Clin Pharmacokinet. 2019;58:1059–68.  https://doi.org/10.1007/s40262-019-00743-7.CrossRefPubMedGoogle Scholar
  7. 7.
    Khalilieh S, Hussain A, Montgomery D, Levine V, Shaw PM, Bodrug I, et al. Effect of tildrakizumab (MK-3222), a high affinity, selective anti-IL23p19 monoclonal antibody, on cytochrome P450 metabolism in subjects with moderate to severe psoriasis. Br J Clin Pharmacol. 2018;84(10):2292–302.  https://doi.org/10.1111/bcp.13670.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Papp K, Thaci D, Reich K, Riedl E, Langley RG, Krueger JG, et al. Tildrakizumab (MK-3222), an anti-interleukin-23p19 monoclonal antibody, improves psoriasis in a phase IIb randomized placebo-controlled trial. Br J Dermatol. 2015;173(4):930–9.  https://doi.org/10.1111/bjd.13932.CrossRefPubMedGoogle Scholar
  9. 9.
    • Reich K, Papp KA, Blauvelt A, Tyring SK, Sinclair R, Thaci D, et al. Tildrakizumab versus placebo or etanercept for chronic plaque psoriasis (reSURFACE 1 and reSURFACE 2): results from two randomised controlled, phase 3 trials. Lancet. 2017;390(10091):276–88.  https://doi.org/10.1016/S0140-6736(17)31279-5Phase III study comparing tildrakizumab to a TNF-α inhibitor. CrossRefPubMedGoogle Scholar
  10. 10.
    • Papp KA, Reich K, Blauvelt A, Kimball AB, Gooderham M, Tyring SK, et al. Efficacy of tildrakizumab for moderate-to-severe plaque psoriasis: pooled analysis of three randomized controlled trials at weeks 12 and 28. J Eur Acad Dermatol Venereol. 2019;33(6):1098–106.  https://doi.org/10.1111/jdv.15400This study presents the predictive value of a PASI 50 response at week 8 for future PASI 90 response. CrossRefPubMedGoogle Scholar
  11. 11.
    •• Reich K, Warren RB, Iversen L, Puig L, Pau-Charles I, Igarashi A, et al. Long-term efficacy and safety of tildrakizumab for moderate-to-severe psoriasis: pooled analyses of two randomised phase III clinical trials (reSURFACE 1 and reSURFACE 2) through 148 weeks. Br J Dermatol. 2019.  https://doi.org/10.1111/bjd.18232The longest and most up to date follow-up of tildrakizumab, following efficacy and safety results for 3 years.
  12. 12.
    Blauvelt A, Reich K, Papp KA, Kimball AB, Gooderham M, Tyring SK, et al. Safety of tildrakizumab for moderate-to-severe plaque psoriasis: pooled analysis of three randomized controlled trials. Br J Dermatol. 2018;179(3):615–22.  https://doi.org/10.1111/bjd.16724.CrossRefPubMedGoogle Scholar
  13. 13.
    Nair RP, Stuart PE, Kullavanijaya P, Kullavanijaya P, Tejasvi T, Voorhees JJ, et al. Genetic evidence for involvement of the IL23 pathway in Thai psoriatics. Arch Dermatol Res. 2010;302(2):139–43.  https://doi.org/10.1007/s00403-009-0986-y.CrossRefPubMedGoogle Scholar
  14. 14.
    Gooderham M, Elewski BE, Pariser DM, Sofen H, Mendelsohn AM, Rozzo SJ, et al. Incidence of serious gastrointestinal events among tildrakizumab-treated patients with psoriasis: letter to the editor. J Eur Acad Dermatol Venereol. 2019.  https://doi.org/10.1111/jdv.15643.
  15. 15.
    Yuan N, Yu G, Liu D, Wang X, Zhao L. An emerging role of interleukin-23 in rheumatoid arthritis. Immunopharmacol Immunotoxicol. 2019;41(2):185–91.  https://doi.org/10.1080/08923973.2019.1610429.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Dermatology Research, Department of DermatologyWake Forest School of MedicineWinston-SalemUSA
  2. 2.Department of PathologyWake Forest School of MedicineWinston-SalemUSA
  3. 3.Department of Social Sciences & Health PolicyWake Forest School of MedicineWinston-SalemUSA
  4. 4.Department of DermatologyUniversity of Southern DenmarkOdenseDenmark

Personalised recommendations