New Data Shows Tildrakizumab Frequently Prescribed for Older, Comorbid Plaque Psoriasis Patients

At the Winter Clinical Miami Conference held in Aventura, Florida, Armstrong et al. presented a large-scale, retrospective cohort study examining the demographic and clinical characteristics of patients with plaque psoriasis (PsO) initiating treatment with tildrakizumab (Ilumya) compared to other systemic treatment classes in the US.¹ This poster is one of 19 abstracts that Sun Pharmaceutical Industries will be sharing at the meeting, including new clinical data on other medications such as clascosterone cream 1% (Winlevi) and deuruxolitinib (Leqselvi).

"The data we are sharing at Winter Clinical Miami reflect our patient-first focus on generating robust clinical and real‑world evidence for the treatment of alopecia areata, plaque psoriasis, and acne," Ahmad Naim, MD, Senior Vice President and North American Chief Medical Officer at Sun Pharma, said in a statement. "Continued scientific evidence is essential to better inform clinical decision-making for dermatology clinicians."²

Background

PsO, which affects approximately 3% of US adults, has seen significant therapeutic advances over the last 2 decades through biologics targeting cytokines such as IL-23, IL-17, and TNF-α.³ Tildrakizumab, approved by the FDA in 2018, is a selective IL-23 inhibitor noted for skin clearance efficacy and robust safety in clinical trials. However, real-world data on the patient profiles initiating tildrakizumab compared with other systemic therapies, including other IL-23 inhibitors (risankizumab, guselkumab), IL-12/23 inhibitors (ustekinumab), IL-17 inhibitors (secukinumab, ixekizumab, bimekizumab, brodalumab), TNF inhibitors, and PDE4 inhibitors (apremilast), remains limited.

Study Design

Utilizing the Komodo Research Database, a nationally representative claims database encompassing diverse payer types, including Medicare Advantage, the investigators identified adult patients (≥18 years) diagnosed with PsO who initiated tildrakizumab or other systemic therapies between April 1, 2018, and June 30, 2025. Inclusion required at least 2 distinct PsO diagnosis claims, 2 treatment claims within a defined timeframe, and continuous health plan eligibility before and after treatment initiation. The primary focus was on demographic variables (age, sex, race/ethnicity, insurance coverage) and clinical parameters, such as comorbidity burden, measured by the Quan-Charlson Comorbidity Index (CCI), and baseline use of topical or systemic therapies.

The analysis encompassed 152,400 patients: 2,339 initiating tildrakizumab, and over 149,000 receiving other systemic agents. Nearly half of the tildrakizumab initiators were enrolled in Medicare, substantially higher than the 9.0–12.6% Medicare enrollment among patients receiving other systemic therapies. Correspondingly, the mean age of patients starting tildrakizumab was 59.8 years, significantly older than the 46.8 to 49.8 years in the comparator groups.

Key Findings

The tildrakizumab cohort demonstrated a greater burden of comorbidities. Mean CCI score was 0.8, markedly higher than the 0.4 to 0.5 range observed in other treatment classes. Specific comorbidities 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 prevalent in the tildrakizumab group, underscoring a medically complex population being treated with tildrakizumab in real-world settings.

Additionally, patients initiating tildrakizumab had a longer mean duration from their first PsO diagnosis to treatment initiation (46.1 months) versus those on other systemic therapies (26.8 to 34.5 months). Topical corticosteroid use was similarly high across cohorts at over 80%, indicating widespread utilization of adjunctive topical treatments.

Potential limitations may include reliance on claims data where diagnosis and treatment coding misclassification may occur, absence of clinical severity measures such as Psoriasis Area and Severity Index (PASI), and lack of direct confirmation that prescribed therapies were administered. Furthermore, procedural claims lacking specified biologic agents were excluded, which may omit some patient data.

Clinical Implications

This real-world trial elucidates important patterns in systemic therapy selection for plaque psoriasis. The preferential use of tildrakizumab in older adults with greater comorbidity burden and Medicare coverage suggests that clinicians may be favoring tildrakizumab’s safety profile in medically complex patients. Given tildrakizumab’s targeted IL-23 inhibition and injection-based administration, it appears to be positioned as a biologic option well-suited for patients with significant comorbid conditions or those covered by Medicare plans. Dermatologists should consider these demographic and clinical factors when individualizing systemic psoriasis therapy. According to the authors, these findings also highlight the need for more granular research on treatment outcomes, persistence, and safety, specifically in medically complex and older PsO populations receiving tildrakizumab to optimize personalized care strategies.

References

1. 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

2. Sun Pharma Showcases Data Across its Dermatology & Immunology Portfolio at 2026 Winter Clinical Miami. News release. PR Newswire. Published February 27, 2026. Accessed February 28, 2026. https://www.prnewswire.com/news-releases/sun-pharma-showcases-data-across-its-dermatology--immunology-portfolio-at-2026-winter-clinical-miami-302699714.html?tc=eml_cleartime

3. Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis Prevalence in Adults in the United States. JAMA Dermatol. 2021;157(8):940-946. doi:10.1001/jamadermatol.2021.2007