The potential utility of tildrakizumab: an interleukin-23 inhibitor for the treatment of psoriasis

Introduction: The approved biologic therapies are effective for the treatment of psoriasis, but have limitations. Tildrakizumab has a different mechanism of action and is a humanized immunoglobulin G1κ that binds to the p19 subunit of IL23. Areas covered: Phase I, II and III clinical trials investigated the pharmacokinetics, efficacy, safety and immunogenicity of tildrakizumab for patients with psoriasis. The mean half‐life of tildrakizumab is between 20.2 to 28.2 days. Tildrakizumab achieved a PASI 75 of 66% and 74% at week 16 for the doses of 100 mg and 200 mg respectively in a phase IIb randomised clinical trial (RCT), and PASI 75 of 61%/64% and 62%/66% at week 12 for 100 mg and 200 mg respectively in two phase III RCTs. Frequently associated adverse events include headache and upper respiratory tract infection. Expert opinion: By recent standards tildrakizumab has relatively modest efficacy, possibly due to a less intensive dosing regimen. Head‐to‐head RCTs in comparison with current therapies such as ustekinumab and secukinumab respectively are needed to understand its relative efficacy. In addition, trials in patients who have failed multiple biologics and patients with psoriatic arthritis would be helpful. The low frequency of injections in the tildrakizumab maintenance regimen may encourage adherence and aid persistence.