P122 Real-world experience of tildrakizumab from a specialist dermatology department at a district hospital in the UK

Abstract

Tildrakizumab, an interleukin-23p19 inhibitor, has demonstrated sustained efficacy in moderate-to-severe plaque psoriasis. At a district hospital in the UK, a retrospective analysis was conducted to assess the short- and long-term effectiveness of tildrakizumab in difficult-to-treat patients with high bodyweight, multiple comorbidities and/or several previous biologic treatments. Doses of 100 mg and 200 mg are used to enable individualized treatment, with the higher dose recommended for patients with high disease burden or bodyweight > 90 kg. This retrospective real-world study at a UK district hospital included 82 adult patients with moderate-to-severe plaque psoriasis treated with tildrakizumab, with assessments at weeks 16, 24, 52 and 104. Nearly all patients (81 of 82) were started on the 100-mg dose. Data were collected for 82 patients with a mean age of 53.6 years. The mean bodyweight was 95.0 kg, 74% had at least one comorbidity and 40% had at least one prior biologic (11% had three or more). Baseline Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores were a mean 9.83 [95% confidence interval (CI) 8.6–11.0] and 17.3 (95% CI 17.1–17.6), respectively. Two-year drug survival was 95.1% (adverse events) and 79.3% (effectiveness). By week 16, PASI decreased to a mean 2.95 (95% CI 2.3–3.6) and DLQI to 6.53 (95% CI 4.37–8.69), with 59%, 42% and 22% of patients achieving PASI scores ≤ 3, ≤ 2 and ≤ 1, respectively, and 33% achieving DLQI 0 or 1. At 104 weeks, response was maintained, with a mean PASI score of 1.49 (95% CI 0.7–2.2) and a mean DLQI score of 2.26 (95% CI 0.3–4.3). In total, 85%, 70% and 65% reached PASI scores of ≤ 3, ≤ 2 and ≤ 1, respectively, and 74% reached DLQI 0 or 1. The 100-mg dose was increased to 200 mg in 32 (39%) patients to increase efficacy; 18 of these patients showed distinct reduction in PASI and DLQI. Tildrakizumab demonstrated sustained drug survival and durable PASI and DLQI improvements over 104 weeks in biologic-naive and biologic-experienced patients, supporting flexible dosing strategies in difficult-to-treat populations.