Tildrakizumab [Ilumetri®; Ilumya™] (tildrakizumab-asmn in the USA) is a humanized monoclonal antibody (mAb) that preferentially targets the p19 component of interleukin (IL)-23, therefore blocking the IL-23/IL-17 axis, the signaling system predominantly implicated in the immunopathogenesis of psoriasis. It is licensed and administered subcutaneously for the adults’ treatment with moderate-to-severe plaque psoriasis who are candidates for systemic therapy (for example, in the EU and Australia), as well as those who are candidates for systemic therapy or phototherapy (in the USA). 

Tildrakizumab was superior to placebo and efficacious compared to etanercept in the pivotal phase III reSURFACE 1 and 2 trials, in terms of the proportion of patients achieving a response [greater than or equal to 75% improvement from baseline in Psoriasis Area and Severity Index score (PASI 75) and a Physician’s Global Assessment score of 0/1] at week 12. 

In the reSURFACE trials and its ongoing open-label extension studies, response rates peaked at week 22, and the vast majority of patients who attained PASI 75 by week 28 maintained this response after a total of three years of medication. Furthermore, patients in the reSURFACE 2 study and its current extension who had a partial or no response to etanercept at week 28 benefited from moving to the highest authorized dose of tildrakizumab. Tildrakizumab treatment increased health-related quality of life and was usually well-tolerated, both in the short and long term. Tildrakizumab, therefore, broadens the spectrum of viable treatment choices for patients with moderate-to-severe plaque psoriasis, particularly those who have not responded adequately to phototherapy or conventional systemic medications.