IL-23 Inhibition Leads in Long-Term Continuity of Care for Medicare Psoriasis Patients

At the Winter Clinical Miami 2026 meeting in Aventura, Florida, real-world data examined treatment persistence and continuity of care among Medicare beneficiaries with plaque psoriasis receiving systemic therapies.¹ The retrospective cohort study by Armstrong et al. evaluated patterns of treatment discontinuation and persistence across multiple biologic and non-biologic systemic agents, with a particular focus on tildrakizumab.

Background

Psoriasis affects approximately 3% of US adults and nearly 4% of those aged 70 years and older.² Over the past 2 decades, management has evolved substantially with the introduction of targeted biologic therapies. Tildrakizumab, an IL-23 p19 inhibitor approved in 2018 for moderate-to-severe plaque psoriasis, has demonstrated strong efficacy and safety in clinical trials. However, comparative real-world evidence in older patients—particularly those enrolled in Medicare—has remained limited.

Study Methodology and Patient Demographics

To address this gap, investigators conducted a longitudinal, claims-based analysis using the nationally representative Komodo Research Database from April 1, 2018, through June 30, 2025. Eligible patients were adults aged 18 years or older enrolled in Medicare with at least 2 psoriasis diagnoses and at least 2 claims for a systemic psoriasis therapy. Patients were required to have at least 6 months of continuous enrollment before and 3 months after treatment initiation. The study identified 16,968 Medicare patients initiating one of the following treatment classes:

• Tildrakizumab (n = 1,162)
• Other IL-23 inhibitors, such as isankizumab and guselkumab (n = 3,388)
• IL-12/23 inhibitors such as ustekinumab and biosimilars (n = 979)
• IL-17 inhibitors (n = 1,876)
• Tumor necrosis factor (TNF) inhibitors (n = 4,415)
• Apremilast (n = 5,148)

Patients initiating tildrakizumab were older than those in other cohorts, with a mean age of 71.6 years compared with 64.9 to 66.9 years in the comparator groups. Approximately half of the patients in each cohort were female. The majority were enrolled in Medicare Advantage plans. Baseline comorbidity burden, as measured by the Charlson Comorbidity Index (CCI), was similar across groups (mean CCI approximately 1.2 to 1.3). Most patients (>85%) had used topical corticosteroids during baseline, underscoring prior treatment exposure.

The primary outcomes were treatment persistence and time to treatment discontinuation (TTD), assessed using Kaplan-Meier analyses. Discontinuation was defined as a gap of at least 3 times the days’ supply between prescription fills.

Key Durability Findings

Tildrakizumab demonstrated the highest persistence rates at all measured time points. At 12 months, 68.6% of patients remained on tildrakizumab compared with 59.7% for other IL-23 inhibitors, 57.5% for IL-12/23 inhibitors, 42.3% for IL-17 inhibitors, 41.5% for TNFis, and 35.6% for apremilast. At 24 months, persistence remained 53.4% for tildrakizumab, whereas comparator therapies ranged from 21.5% (apremilast) to 44.9% (other IL-23 inhibitors).

Median TTD further highlighted differences in durability. Patients initiating tildrakizumab had a median TTD of 29.0 months (95% CI, 24.0–35.2), notably longer than other IL-23 inhibitors at 18.5 months (95% CI, 17.2–20.3) and IL-12/23 inhibitors at 16.8 months (95% CI, 14.4–18.6). Shorter median TTDs were observed for IL-17 inhibitors (9.2 months), TNFis (8.9 months), and apremilast (7.2 months). Overall discontinuation rates ranged from 39.2% in the tildrakizumab cohort to more than 70% in the IL-17, TNFi, and PDE4 inhibitor groups during follow-up.

Conclusion

The authors did note several limitations, including the potential misclassification of diagnoses, inability to confirm medication adherence, and reliance on administrative definitions of discontinuation. Nonetheless, the large, nationally representative Medicare population provides meaningful insight into real-world treatment patterns among older adults. In a population often characterized by greater clinical complexity and comorbidity burden, these results underscore durable continuity of care with IL-23 inhibition in routine clinical practice.

References

1. Armstrong A, Behl A, Huynh L, et al. Real World Continuity of Care for Medicare Patients with Plaque Psoriasis Treated with Tildrakizumab and Other Treatment Classes. Poster presented at: 2026 Winter Clinical Miami Dermatology Conference; February 27-March 1, 2026; Aventura, FL

2. Iskandar IYK, Parisi R, Griffiths CEM, Ashcroft DM; Global Psoriasis Atlas. Systematic review examining changes over time and variation in the incidence and prevalence of psoriasis by age and gender. Br J Dermatol. 2021;184(2):243-258. doi:10.1111/bjd.19169