Update on Tildrakizumab for Psoriasis
- 3 Downloads
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.
Tildrakizumab maintains efficacy in moderate-to-severe plaque psoriasis for up to 3 years with low risk of adverse events.
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.
KeywordsTildrakizumab Ilumya IL23p19 Efficacy Safety Long term
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 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.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.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.• 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.• 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.•• 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.
- 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.