Early PASI Improvement via Tildrakizumab Predicts Response in Patients With Plaque Psoriasis

An example of plaque psoriasis on a patient's back
An example of plaque psoriasis on a patient’s back
Differences in responses in patients who eventually achieved PASI improvement <50% and ≥50% could be differentiated as early as week 8, after two doses of tildrakizumab.

The likelihood of response to tildrakizumab in patients with moderate to severe plaque psoriasis, based on improvements in the Psoriasis Area and Severity Index (PASI), can be identified early in the course of therapy, a study published in the Journal of the European Academy of Dermatology and Venereology suggests.

The study was a pooled analysis of patient data from the phase 3 reSURFACE 1 and reSURFACE 2 trials, which included a total of 575 patients with moderate to severe plaque psoriasis who were treated with tildrakizumab 100 mg, and 581 similar patients who were treated with 200 mg from baseline to week 28.

In this analysis, patients were classified into 5 mutually exclusive week 28 PASI improvement groups for each dose: PASI <50 (100 mg, n=48; 200 mg, n=23), PASI 50 to 74 (100 mg, n=82; 200 mg, n=105), PASI 75 to 89 (100 mg, n=137; 200 mg, n=114), PASI 90 to 99 (100 mg, n=175; 200 mg, n=169), and PASI 100 (100 mg, n=133; 200 mg, n=170). Each group was examined for the mean PASI improvement and Dermatology Life Quality Index 0/1 over time.

In the tildrakizumab 100-mg group, the percentages of patients who achieved PASI <50, 50 to 74, 75 to 89, 90 to 99, and 100 at week 28 were 8.3%, 14.3%, 23.8%, 30.4%, and 23.1%, respectively. The percentages of patients who achieved PASI <50, 50 to 74, 75 to 89, 90 to 99, and 100 at week 28 in the 200 mg tildrakizumab group were 4.0%, 18.1%, 19.6%, 29.1%, and 29.3%, respectively.

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Patients unlikely to respond to tildrakizumab (PASI <50 at week 28) were identified by week 8. Individuals with a PASI of ≥90 by week 28 had a 50% improvement in PASI by week 4. There were improvements in or maintenance of the mean PASI scores in patients who achieved 28-week PASI of >50 and who continued to use the same tildrakizumab dose to week 52. Achievement of higher PASI responses by week 28 was more often associated with the likelihood of achieving Dermatology Life Quality Index 0/1 at week 28 compared with patients with lower PASI responses.

Limitations of this analysis included the lack of real-world patient data as well as the lack of data on symptom control or body surface area improvement after treatment with tildrakizumab.

Findings from this pooled analysis are potentially important “because they suggest that patients and their healthcare providers can make an educated decision as to whether to continue tildrakizumab therapy or not by week 12 or 16.”

Disclosure: This clinical trial was supported by Sun Pharmaceutical Industries, Inc. Please see the original reference for a full list of authors’ disclosures.

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Blauvelt A, Sofen H, Papp K, et al. Tildrakizumab efficacy and impact on quality of life up to 52 weeks in patients with moderate-to-severe psoriasis: a pooled analysis of two randomized controlled trials [published online August 13, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15862