Nail Psoriasis and Real-World Data Highlight Tildrakizumab’s Staying Power

Two posters presented at the American Academy of Dermatology (AAD) Annual Meeting highlight both clinical trial efficacy and real-world durability of tildrakizumab, an interleukin (IL)-23 p19 inhibitor, in patients with moderate-to-severe plaque psoriasis.

In a Phase 3b, randomized, double-blind, placebo-controlled trial (NCT03897075), investigators evaluated tildrakizumab in patients with moderate-to-severe psoriasis affecting the nails—a manifestation that remains challenging to treat. A total of 99 patients were randomized to tildrakizumab 100 mg or placebo, with placebo patients crossing over at Week 28. 

Efficacy endpoints included ≥75% improvement in modified Nail Psoriasis Severity Index (mNAPSI 75) and the ViSENPsO response. Response rates increased from Week 28 to Week 52, with at least 60% of Week 28 responders maintaining responses through one year. Patients initially assigned to placebo demonstrated marked improvement after switching to tildrakizumab. Nail pain outcomes also favored active treatment, with 60.6% of patients achieving ≥30% reduction at Week 28 versus 31.4% with placebo (nominal P = 0.02). 

Safety findings through Week 72 were consistent with prior experience, with no new signals identified.

“The efficacy of tildrakizumab in moderate-to-severe nail psoriasis was maintained through Week 52, and patients switching from placebo to tildrakizumab at Week 28 showed subsequent improvement. No new safety signals were observed through Week 72,” the authors concluded. 

Complementing these controlled data, a real-world analysis from the CorEvitas Psoriasis Registry evaluated treatment persistence among 647 US patients initiating tildrakizumab between 2018 and 2024. Patients had a mean age of 59 years, and more than half had prior biologic exposure.

Among patients with follow-up, the median time on tildrakizumab was 28.0 months, and 68.5% remained on therapy at 12 months. Persistence varied by insurance type, with higher 1-year persistence among Medicare (72.1%) and Medicaid (63.6%) patients compared with private insurance (60.6%). Discontinuations were infrequent due to safety (3.9%) and more often attributed to other factors, including access and treatment preferences. 

“In this registry-based US cohort study, tildrakizumab initiators had a median time on drug of more than 2 years, and fewer than half of discontinuations were due to safety or effectiveness,” the authors wrote, noting that “these real-world findings support the safety and effectiveness of tildrakizumab for patients with plaque psoriasis.”