Tildrakizumab Gains Popularity Among Older Patients with Plaque Psoriasis
Research Insights from the Winter Clinical Miami Conference
During the recent Winter Clinical Miami Conference in Aventura, Florida, a significant study was presented by Armstrong et al. This large-scale, retrospective cohort analysis explored the demographic and clinical characteristics of patients with plaque psoriasis (PsO) who began treatment with tildrakizumab (Ilumya), in comparison to other systemic treatment classes within the United States. This poster is part of a broader dissemination of findings by Sun Pharmaceutical Industries, which is sharing a total of 19 abstracts at this important meeting, including new clinical data on medications such as clascosterone cream 1% (Winlevi) and deuruxolitinib (Leqselvi).
“The data we are presenting at Winter Clinical Miami underscore our commitment to a patient-first approach, focusing on generating comprehensive clinical and real-world evidence for the management of conditions such as alopecia areata, plaque psoriasis, and acne,” stated Ahmad Naim, MD, Senior Vice President and North American Chief Medical Officer at Sun Pharma.
Importance of Scientific Evidence
“Ongoing scientific evidence is critical to enhance clinical decision-making for dermatology professionals,” he added. Psoriasis, which impacts roughly 3% of adults in the United States, has experienced considerable advancements in treatment options over the past two decades, primarily through the development of biologics that target specific cytokines, including IL-23, IL-17, and TNF-α. Tildrakizumab, which received FDA approval in 2018, is a selective IL-23 inhibitor recognized for its effectiveness in achieving skin clearance and maintaining a favorable safety profile in clinical trials.
Despite its advantages, there is a notable gap in real-world data concerning the patient demographics initiating treatment with tildrakizumab compared to those undergoing other systemic therapies. These therapies include other IL-23 inhibitors such as risankizumab and guselkumab, IL-12/23 inhibitors like ustekinumab, IL-17 inhibitors including secukinumab, ixekizumab, bimekizumab, and brodalumab, as well as TNF inhibitors and PDE4 inhibitors like apremilast.
Study Design Overview
Utilizing the Komodo Research Database, which is a nationally representative claims database that includes a variety of payer types, including Medicare Advantage, the researchers identified adult patients (≥18 years) diagnosed with PsO who initiated treatment with tildrakizumab or other systemic therapies between April 1, 2018, and June 30, 2025.
Inclusion criteria mandated at least two distinct claims indicating a diagnosis of PsO, along with two treatment claims within a specific timeframe, and continuous eligibility for health plans before and after the initiation of treatment. The primary focus of the study was on demographic factors such as age, sex, race/ethnicity, and insurance coverage, as well as clinical parameters, including the comorbidity burden assessed by the Quan-Charlson Comorbidity Index (CCI) and the baseline usage of topical or systemic therapies.
The analysis included a total of 152,400 patients: 2,339 who started tildrakizumab and over 149,000 receiving other systemic agents. Remarkably, nearly half of the patients initiating tildrakizumab were enrolled in Medicare, a stark contrast to the 9.0% to 12.6% Medicare enrollment rate observed among those receiving alternative systemic therapies.
Additionally, the average age of patients beginning treatment with tildrakizumab was 59.8 years, significantly older than the 46.8 to 49.8 years seen in the comparison cohorts.
Key Findings from the Study
The cohort receiving tildrakizumab exhibited a greater burden of comorbidities, with a mean CCI score of 0.8, which is markedly higher than the 0.4 to 0.5 range found in other treatment classes. Specific comorbid conditions such as diabetes (24.5% vs. 13.6% to 15.7%), hypertension (47.4% vs. 28.1% to 32.1%), and hyperlipidemia (47.0% vs. 26.9% to 30.1%) were more common among patients treated with tildrakizumab, highlighting the medically complex nature of this population in real-world scenarios.
Moreover, patients who initiated tildrakizumab demonstrated a longer mean duration from their first PsO diagnosis to the start of treatment, averaging 46.1 months, compared to 26.8 to 34.5 months for those on alternative systemic therapies.
Topical corticosteroid use was similarly prevalent across all cohorts, exceeding 80%, indicating a widespread practice of utilizing adjunctive topical treatments.
Limitations of the Study
Some potential limitations of this research may involve the reliance on claims data, which can lead to misclassification in diagnosis and treatment coding. Additionally, the study lacked clinical severity measures such as the Psoriasis Area and Severity Index (PASI) and did not provide direct verification that the prescribed therapies were actually administered.
Furthermore, procedural claims that did not specify biologic agents were excluded, which could omit crucial patient data from the analysis.
Clinical Implications
This real-world study sheds light on significant trends regarding systemic therapy selection for plaque psoriasis. The preference for tildrakizumab among older adults with higher comorbidity burdens and Medicare coverage suggests that clinicians may prioritize the safety profile of tildrakizumab for treating medically complex patients.
Given tildrakizumab’s mechanism of targeted IL-23 inhibition and its method of injection-based administration, it seems to be well-positioned as a biologic option suitable for patients with significant comorbidities or those enrolled in Medicare plans.
Dermatologists are encouraged to take these demographic and clinical variables into account when tailoring systemic therapy for patients with PsO. According to the authors, these findings also underscore the necessity for further in-depth research on treatment outcomes, persistence, and safety within medically complex and older populations receiving tildrakizumab, ultimately aiming to refine personalized care strategies.
Armstrong A, Behl A, Huynh L, et al. Real World Use of Tildrakizumab and Other Treatment Classes in Complex, Medicare Patients with Plaque Psoriasis. Poster presented at: 2026 Winter Clinical Miami Dermatology Conference; February 27-March 1, 2026; Aventura, FL.
Sources
- Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis Prevalence in Adults in the United States. JAMA Dermatol. doi:10.1001/jamadermatol.2021.2007.
- Sun Pharma Showcases Data Across its Dermatology & Immunology Portfolio at 2026 Winter Clinical Miami. Published February 27, 2026. Accessed February 28, 2026. link.