Tildrakizumab treatment patterns in moderate-to-severe plaque psoriasis: Canadian real-world evidence
Today's report also covers novel oral inhibitors, real-world switching patterns, and more (1,400 words, 6 minutes, 30 seconds)
The Vender on Psoriasis e-newsletter is supported by an unrestricted grant from Sun Pharma Canada
Good morning and welcome to the 22nd issue of Special Reports: Skin Spectrum Weekly presents “Vender on Psoriasis.” This series is based on Dr. Vender’s popular column appearing in each edition of The Chronicle of Skin & Allergy, which offers expert commentary and opinions on current clinical developments in PsO. We’d love to get your feedback and suggestions and invite you to be in touch. Please write to us at health@chronicle.org
Tildrakizumab treatment patterns in moderate-to-severe plaque psoriasis: Canadian real-world evidence
Tildrakizumab, an anti–IL-23p19 monoclonal antibody, is approved for adults with moderate-to-severe plaque psoriasis suitable for phototherapy or systemic therapy. Real-world data on its treatment patterns remain limited. This retrospective study evaluated persistence and adherence to tildrakizumab using data from the Canadian patient support program (PSP), which delivers reimbursement, financial support, and injection training.
An observational cohort was assembled from the Canadian tildrakizumab PSP database, including adults (≥18 years) diagnosed with moderate-to-severe plaque psoriasis receiving ≥6 months of tildrakizumab between August 2021 and August 2023. Persistence was defined as time on therapy until discontinuation. Adherence was measured using the proportion of days covered (PDC), with ≥80% considered high adherence. Adverse events and reasons for discontinuation were captured.
The sample included 813 patients (mean age 49.6 years; 55% male; 92.7% biologic-naïve), for a mean treatment duration of 330 days. At one year, 88% remained on therapy. Regarding adherence, mean PDC was 97.5%, with 93.5% achieving PDC ≥80%. A total of 85 patients stopped therapy, with the primary reasons including switching to other treatments (36.5%) and prescriber decisions (23.5%).
The most frequent adverse outcomes were treatment misuse (18.9%), disease flare (8.2%), and discontinuation (7.4%). Other notable events included infection (3.9%) and post-injection reaction (3.9%).
This is the first Canadian real-world study on tildrakizumab in this population, demonstrating robust persistence and high adherence at one year. The majority of discontinuations were related to therapeutic switching rather than safety or inefficacy; disease management benefits appear supported by the long dosing interval and favorable safety seen in clinical trials. Compared with other biologics, IL-23 inhibitors like tildrakizumab generally show superior persistence and adherence, attributed partly to less frequent dosing.
In summary, Canadian patients with moderate-to-severe plaque psoriasis enrolled in the PSP maintained high persistence and adherence to tildrakizumab over one year, supporting its real-world effectiveness and the utility of support programs in optimizing chronic disease management. These findings highlight the importance of PSPs in driving medication adherence and persistence, potentially translating to reduced healthcare burden and improved patient outcomes. Future studies should explore approaches to further improve long-term management across diverse care settings.
Comment: This Canadian real-world evidence study on tildrakizumab provides valuable insights: 88% of patients stayed on treatment for a full year, and over 93% were highly adherent. These are outstanding persistence numbers—especially considering that 92.7% were biologic-naïve. Most discontinuations were due to switching, not safety or loss of response.
I was particularly interested in the high adherence rate (PDC 97.5%)—a testament to both the tolerability of IL-23 inhibitors and the utility of Canadian patient support programs (PSPs). Long intervals between doses likely contribute to real-world success, particularly for busy patients.
My takeaway: Tildrakizumab holds up well in practice—not just in trials. This data should give prescribers confidence, especially when starting patients new to biologics. PSPs remain a critical factor in patient success and should be supported in chronic disease care.
Understanding psoriasis risk with immune checkpoint inhibitors
This cohort study investigated the association between immune checkpoint inhibitor (ICI) therapy and the risk of psoriasis in cancer patients (JAMA Dermatol2025; 161(1):31-38. doi:10.1001/jamadermatol.2024.4129). The researchers utilized data from the Taiwan National Health Insurance database and the Taiwan Cancer Registry, employing a target trial emulation framework to minimize common biases.
The study included 135,230 patients who received antineoplastic medications between Jan. 2019 and June 2021. Of these, 3,188 were treated with ICIs (PD-1 and PD-L1 inhibitors), while 132,042 received chemotherapy or targeted therapies. The mean follow-up period was 1.46 years.
The researchers found that ICI users experienced a higher incidence of psoriasis (5.76 cases per 1,000 person-years) compared to non-ICI users (1.44 cases per 1,000 person-years). After adjusting for demographics, comorbidities, and outpatient visits, ICI users showed a significantly increased risk of developing psoriasis: Cox proportional hazards model: IPTW-adjusted HR of 3.31; Fine-Gray subdistribution hazard model: IPTW-adjusted SHR of 2.43.
They noted the risk of developing psoriasis was highest within the first 180 days of ICI initiation (IPTW-adjusted SHR, 7.69). Subgroup analyses revealed statistically significant higher risks among ICI users aged 66 years and older, as well as male patients.
Comparison with other anticancer therapies showed that ICI users had the highest risk of psoriasis, followed by protease kinase inhibitor users, with chemotherapy and monoclonal antibody users showing the least risk.
The study’s strengths include its large-scale, nationwide design and the use of a simulated target trial framework to minimize biases. However, limitations include the lack of data on lifestyle factors, genetic predisposition, and psoriasis severity.
The authors propose that the increased risk of psoriasis in ICI users may be related to the shared biological processes between psoriasis and ICI-induced immune-related adverse events. ICIs block inhibitory pathways such as PD-1/PD-L1, leading to T cell reactivation and potentially enhanced immune activity, which may manifest as psoriasis.
This study demonstrates a higher risk of psoriasis in cancer patients receiving ICI therapy compared to those on chemotherapy or targeted therapy. While this adverse effect is relatively uncommon, the findings highlight the importance of awareness among medical professionals to ensure optimal cancer care and skin health management in patients undergoing ICI treatment.
Comment: This study offers an analysis of the increased risk of psoriasis among cancer patients treated with immune checkpoint inhibitors (ICIs). The use of a large, nationwide cohort and target trial reduces selection bias, strengthening its validity. The finding that ICI users have over three times the risk of developing psoriasis compared to non-ICI users underscores the immunomodulatory effects of PD-1/PD-L1 inhibition. However, limitations include the lack of genetic and lifestyle data, which can influence psoriasis risk. Clinically, this study highlights the importance of derm monitoring in patients receiving ICIs, especially in older men who appear at higher risk.
Development of measurement tools to assess cumulative life course impairment in patients with chronic skin diseases
This paper describes the development of two measurement tools designed to assess Cumulative Life Course Impairment (CLCI) in patients with chronic skin diseases (J Eur Acad Dermatol Venereol wileyonlinelibrary.com/journal/jdv 2023;37:1626–1633). CLCI refers to the non-reversible damage caused by persistent disease burden over time, influencing patients’ life trajectories through psychological, social, and emotional impairments. The study aimed to create instruments that measure persisting CLCI retrospectively and identify patients at risk for future CLCI.
The development process involved multiple stages, including a systematic literature review, analysis of patient registry data, open item selection, focus group interviews, item conception, cognitive debriefing, and finalization. The open item selection involved 162 patients with psoriasis, atopic dermatitis, or hidradenitis suppurativa, who identified key topics impacting their life course. Focus group interviews with 19 patients and 13 experts further refined these topics and highlighted additional areas of concern.
Two measurement tools were developed: DermCLCI-r and DermCLCI-p. DermCLCI-r consists of 30 items assessing retrospective impairments due to skin disease over the disease life course, using 4-point and 5-point Likert scales. It also includes questions about ongoing burden and life-changing impact. DermCLCI-p, also comprising 30 items, evaluates current CLCI status and future risk within the last two weeks, primarily using a 4-point Likert scale.
The authors argue that these tools are more suitable and specific for dermatologic conditions compared to existing measures such as the Major Life Changing Decision Profile (MCLDP) and Life Change Index. They emphasize the importance of distinguishing between existing CLCI and the risk for future CLCI to provide appropriate support and interventions.
While the study presents a comprehensive approach to tool development, limitations include the focus on only three skin diseases and recruitment from a single centre in Germany. The authors acknowledge the need for further international studies and psychometric testing for validity and reliability.
This project provides much-needed instruments to assess previous CLCI and contribute to the prevention of CLCI in patients with chronic skin diseases. The tools are expected to facilitate early identification of CLCI, enable adequate dermatological and psychosocial interventions, and potentially prevent CLCI. Future research plans include linguistic and cross-cultural validations for international use, as well as adaptations for additional skin diseases. These instruments represent an important step toward developing people-centered psychosocial interventions to prevent and reduce the risk of CLCI in patients’ lives.
Comment: This study introduces DermCLCI-r and DermCLCI-p, two tools designed to assess Cumulative Life Course Impairment (CLCI) in chronic skin diseases. The strengths include a rigorous, multi-stage development process and disease-specific focus, distinguishing it from broader psychosocial measures. The ability to assess both past and future CLCI enhances clinical relevance. However, limitations include its focus on only three diseases and single-centre recruitment, limiting generalizability. These tools provide a patient-centred approach to dermatologic care, enabling earlier psychosocial interventions. Future research should prioritize cross-cultural validation and adaptation for other skin conditions.
If you find the contents of this newsletter interesting, please check out the Vender on Psoriasis podcast. It’s available at Apple iTunes, Stitcher, Spotify, or wherever you get your podcasts.
Dr. Ron Vender is a Hamilton-based certified dermatologist with over 30 years of clinical practice experience and over 100 clinical trials in psoriasis. He is founder and director of Dermatrials Research Incorporated and Venderm Consulting, specializing in treatments and management solutions for individuals with psoriasis.
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