INDIVIDUAL ARTICLE: Tildrakizumab for Real-World Psoriasis Care: Clinical Lessons From Medically Complex and Underserved Patient Populations
October 2026 | Volume 25 | Issue 10 | 435801s4 | Copyright © October 2026
Published online October 1, 2026
Julian A. Cortes BSa, Boni Elewski MDb, Sam Awan MDc, Michael O’Donoghue MDd, Alex Glazer MDe, Todd Schlesinger MDf, Raj Chovatiya MD PhDg, h, Christopher G. Bunick MD PhDi, Leon H. Kircik MDj, April W. Armstrong MD MPHk
aUniversity of California, San Diego, School of Medicine, San Diego, CA
bDepartment of Dermatology, University of Alabama at Birmingham, AL
cU.S. Dermatology Partners, McKinney, TX
dIllinois Dermatology Institute, La Grange, IL
eGlazer Dermatology, Dermatology Science and Research Foundation, Buffalo Grove, IL
fClinical Research Center of the Carolinas, Charleston, SC; Department of Dermatology, The George Washington University School of Medicine and Health Sciences, DC
gChicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL
hCenter for Medical Dermatology + Immunology Research, Chicago, IL
iDepartment of Dermatology, Program in Translational Biomedicine, and Institute for Global Health, Yale School of Medicine, New Haven, CT
jIcahn School of Medicine at Mount Sinai, New York, NY
kDivision of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
Abstract
Tildrakizumab, a humanized monoclonal antibody targeting the p19 subunit of interleukin-23, has demonstrated durable efficacy and a favorable long-term safety profile in moderate-to-severe plaque psoriasis. However, patients encountered in clinical practice frequently have comorbidities, treatment barriers, and social circumstances that are underrepresented in randomized clinical trials. This case review describes 16 patients treated with tildrakizumab across clinically relevant populations, including older adults, patients with cardiometabolic disease or complex medical comorbidities, and individuals with unique treatment considerations. Across these cases, tildrakizumab was associated with substantial improvement in psoriasis, including involvement of high-impact sites such as the scalp, nails and intertriginous regions. Durable disease control was observed in patients with prior malignancy, chronic infection, hepatic disease, cardiovascular comorbidities, polypharmacy, and prior biologic failure, without treatment-limiting adverse events attributed to tildrakizumab. In-office administration and every-12-week maintenance dosing also offered practical advantages for patients facing Medicare-related access considerations, self-injection aversion, inconsistent healthcare access, or adherence challenges. These cases demonstrate how tildrakizumab may be integrated into individualized psoriasis management and highlight its potential as a practical, effective, and well-tolerated treatment option across diverse real-world clinical settings.
J Drugs Dermatol. 2026;25:10(Suppl 2):s4-14.
INTRODUCTION
Tildrakizumab is a humanized immunoglobulin G1 (IgG1) monoclonal antibody that selectively binds the p19 subunit of interleukin-23 (IL-23), a key cytokine in the pathogenesis of psoriasis.1-4 In the pivotal phase 3 reSURFACE 1 and 2 clinical trials, tildrakizumab demonstrated efficacy in the treatment of moderate-to-severe plaque psoriasis, with over 60% of patients achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI-75) at week 12 from baseline.5 These findings supported tildrakizumab’s approval by the US Food and Drug Administration as a 100 mg subcutaneous injection at weeks 0, 4, and every 12 weeks thereafter.6
The long-term safety and efficacy of tildrakizumab have been further demonstrated in long-term extension studies over 5 years. Among responders to tildrakizumab at week 28, at least 88% maintained PASI-75, 65% maintained PASI-90, and 32% achieved PASI-100 at week 244.7-8 Taken together, these findings support the durability of response and favorable long-term safety profile of tildrakizumab in the treatment of patients with moderate-to-severe plaque psoriasis.
Unlike many biologic therapies, tildrakizumab is typically administered within a healthcare setting. As a result, tildrakizumab may be billed under Medicare Part B, which generally covers physician-administered medications, rather than Medicare Part D, which primarily covers self-administered prescription drugs, potentially reducing out-of-pocket costs and improving access in the Medicare population.9-11 These features make tildrakizumab well-suited for populations frequently underrepresented in clinical trials, but commonly encountered in real-world clinical practice. In particular, tildrakizumab may be an important therapeutic option for elderly patients and especially for those with complex medical comorbidities, cardiometabolic disease, or unique social circumstances.
