Tildrakizumab Efficacy Similar to Other Psoriasis Biologics Among Patients in Asia

Tildrakizumab treatment is effective among patients in Asia with moderate-to-severe plaque psoriasis, new data suggest, with comparable outcomes to other biologics by Week 28 and allowing for infrequent dosing.1

These data were authored by a team of investigators led by Akihiko Asahina, MD, PhD, from the Jikei University School of Medicine in Tokyo. The findings resulted from an analysis by Asahina et al in which the efficacy of current psoriasis medications among patients in Asia were reviewed and compared to tildrakizumab, an interleukin (IL)-23 inhibitor.

Although network meta-analyses (NMAs) had previously been conducted comparing various biologic agents’ efficacy in psoriasis, Asahina and coauthors highlighted that the majority of such analyses did not take into account the possible geographical variations in treatment response due to differences in genetic makeup and pre-biologic treatment histories.2

“To address these limitations, we conducted a systematic literature review (SLR) and NMA comparing the induction period (12 and 16 weeks) and mid-term (28 weeks) efficacy of biologics in the Asian population, with the specific aim of evaluating the efficacy of tildrakizumab compared with other approved biologic therapeutic regimens,” the investigative team wrote.1

Review and Meta-Analysis

In January 2024, the study’s investigators carried out a literature review using the MEDLINE, CENTRAL, and Embase databases, seeking to identify randomized controlled trials (RCTs) assessing the efficacy and safety of biologic therapies in adult Asian patients living with moderate-to-severe psoriasis. They assigned 2 independent reviewers to screen available data based on abstracts, titles, and full-texts.

Resolution of any disagreements between reviewers were addressed through discussion or adjudication by a third reviewer. Asahina and colleagues extracted data relevant to the study objectives from the articles that met inclusion criteria after a full-text review. They conducted NMAs conducted for individuals attaining at least 75%, 90%, and 100% improvement in Psoriasis Area and Severity Index scores (PASI 75, 90, and 100) and achieving a Physician Global Assessment (PGA) score of 0 or 1.

When placebo data were missing at a specific timepoint, responses were carried forward from the most recent available data. For example, if a placebo cohort had been re-randomized at the 16-week mark, the Week 16 placebo response was used for the 28-week analysis. Outcomes were examined by Asahina et al by the end of the induction period (12 and 16 weeks) and mid-term follow-up at 28 weeks.

Analyses followed a Bayesian framework consistent with National Institute of Clinical Excellence guidelines. The investigators used a feasibility assessment to evaluate baseline characteristics and placebo responses across RCTs. This evaluation demonstrated differences in baseline patient characteristics and a correlation between prior biologic exposure and placebo response.

A total of 19 RCTs conducted in 4 regions of Asia involving 11 different biologics were included. At the 12-week mark, tildrakizumab demonstrated lower efficacy relative to other biologic agents. However, between Weeks 12 and 28, the proportion of patients achieving PASI 75/90/100 with tildrakizumab rose from 60.77% to 81.84%, 38.54% to 71.23%, and 6.97% to 22.64%, respectively.

By the 28-week mark, the efficacy of tildrakizumab was shown by Asahina and coauthors to be similar to other biologics options, including tumor necrosis factor-alpha (TNFα) inhibitors, IL-12/IL-23 inhibitors, IL-17 inhibitors, and other IL-23 inhibitors. The investigative team's conclusions highlight the progressive improvement of tildrakizumab over the course of time, emphasizing the importance of evaluating its sustained efficacy. Combined with its infrequent dosing schedule, tildrakizumab was noted to represent a potent option for therapy for adults with moderate-to-severe psoriasis.

Overall, these data were also noted by the investigators to align with both clinical research and real-world evidence, suggesting that a set of 3 doses of tildrakizumab can achieve meaningful clinical efficacy, which can then be maintained with ongoing tree.

“Tildrakizumab should, therefore, be considered an effective treatment option for patients with plaque psoriasis that may reduce treatment burden due to its lower dosing frequency,” they concluded.1

References

1. A Asahina, MS Fazeli, R Kendall, et al. Efficacy of Biologics for the Treatment of Moderate-To-Severe Plaque Psoriasis in the Asian Population: A Systematic Review and Network Meta-Analysis,” International Journal of Dermatology (2025): 1–11. https://doi.org/10.1111/ijd.70092.

2. Tsai TF, Tada Y, Armstrong AW, et al. Indirect comparison of deucravacitinib and other systemic treatments for moderate to severe plaque psoriasis in Asian populations: A systematic literature review and network meta-analysis. J Dermatol. 2024 Dec;51(12):1559-1571. doi: 10.1111/1346-8138.17448. Epub 2024 Nov 11. PMID: 39526612; PMCID: PMC11624152.