Tildrakizumab for Moderate-to-Severe Plaque Psoriasis

Uyen Ngoc Mui, MD; Ravi R. Patel, MD; Ramya Vangipuram, MD; Stephen K. Tyring, MD, PhD


Skin Therapy Letter. 2019;24(6):1-4. 

In This Article

Abstract and Introduction


Psoriasis is an immune-mediated inflammatory skin condition associated with many comorbidities and poor quality of life. The pathogenesis of psoriasis is complex and involves numerous proinflammatory cytokines. Many biologic therapies have been developed to block the action of these proinflammatory molecules, including inhibitors of tumor necrosis factor (TNF), interleukin (IL)-17, IL-12, and IL-23. IL-23 is composed of two subunits, p19 and p40. The p40 subunit is shared with IL-12, and inhibitors of the p40 subunit can block both IL-12 and IL-23 signaling. Recent advances in the understanding of psoriasis, however, have shown IL-23 to be more important than IL-12 in the pathogenesis of psoriasis. This has led to the development of IL-23p19 antagonists, the newest class of biologics for psoriasis. Here, we will discuss the safety and efficacy of tildrakizumab, a monoclonal antibody targeting IL-23p19.


Psoriasis is a chronic, immune-mediated inflammatory skin condition characterized by well-defined erythematous plaques, scaling, itching, and burning. Plaque psoriasis is the most common type of psoriasis in older children and adults.[1] While two-thirds of patients develop psoriasis in adulthood, onset of childhood psoriasis is quite common.[1] Prevalence varies by country and is estimated to be 0.5–11% in adults and 1% in children.[2–4] Psoriasis is associated with many comorbidities and has a considerable impact on the quality of life, particularly in those with moderate-to-severe disease.[1,2,4] One-fifth of all patients who have psoriasis are diagnosed with moderate-to-severe disease, highlighting a need for safe, effective, and reliable treatments.[2]