Tildrakizumab For PsA

In a previous supplement published in March 2021, we discussed the pivotal data for the interleukin (IL)-23 p19 inhibitor, tildrakizumab, for use in plaque psoriasis. The reSURFACE-1 and reSURFACE-2 clinical trial program demonstrated the durable efficacy and safety of tildrakizumab in the moderate-to-severe plaque psoriasis population. We have also seen 5-year efficacy and safety data confirming the durability of response along with no new safety concerns having arisen in the long term. Recently, tildrakizumab (Ilumya^TM, Sun Pharma Canada) therapy was approved for use in Canada for plaque psoriasis. The safety, efficacy, durability and convenience of four doses a year after the loading dose, makes tildrakizumab an attractive therapy for a chronic disease such as psoriasis. We also know that one-third of our psoriasis patients will develop psoriatic arthritis over their lifetime. When choosing a therapy that can treat both skin and joints, targeting IL-23 is an important option to consider. Conventional therapies for psoriatic arthritis (methotrexate, leflunomide, sulfasalazine) are burdened with tolerability issues, adverse effects and end-organ toxicity. Current biologics, including TNF-α inhibitors and IL-17 inhibitors, are quite effective for the management of psoriatic arthritis, but also suffer from tolerability issues, loss of efficacy, and adverse effects related to their mechanism of action. Tildrakizumab, and its mechanism of targeting IL-23, is also being studied in psoriatic arthritis and inflammatory bowel disease since IL-23 plays an important role in regulating these conditions as well. Currently we have other IL-23 inhibitors which have shown the importance of blocking IL-23 in the treatment of psoriatic arthritis. Guselkumab is already approved for use and emerging phase 3 clinical trial data (KEEPsAKE-1, KEEPsAKE-2) supports the use of risankizumab in psoriatic arthritis as well. 

The phase 2b data for tildrakizumab in psoriatic arthritis is presented in this supplement, highlighting the expected efficacy and safety with IL-23 inhibition. Tildrakizumab is a treatment that offers all the attributes of IL-23 inhibition: safety, efficacy, convenience, and overall improvement in quality of life. High rates of ACR20/50/70 in this early phase trial look promising but phase 3 results are needed to confirm the phase 2b data. These results, along with the impact on other important domains of disease such as improvement of dactylitis and enthesitis, quality of life and long-term use data are eagerly anticipated.