Tildrakizumab delivers sustained improvements in psoriasis severity and patient-reported outcomes, although the relationship between skin clearance and quality-of-life measures appears to weaken over longer-term treatment, according to a recent Italian study.
Chronic plaque psoriasis is associated with substantial physical, psychological and social burdens that may not be fully reflected by clinical severity scores alone.
Published in the journal Dermatology and Therapy, a prospective real-world study evaluated the impact of the monoclonal antibody tildrakizumab on disease severity, symptoms and health-related quality of life in 33 patients with moderate-to-severe chronic plaque psoriasis.
Correlations between improvements in Psoriasis Area and Severity Index (PASI) scores and patient-reported outcome measures (PROMs) over time were also evaluated.
Patients were biologic-naive and were followed for 52 weeks, with assessments conducted at baseline, week 16 and week 52. The cohort was predominantly male, with a mean age of 50 years and a mean disease duration of 22.1 years.
Clinical outcomes included PASI responses, while PROMs comprised the Dermatology Life Quality Index (DLQI), Skindex-16 and visual analogue scale scores for pruritus, scaling and pain.
Impact on sleep and productivity was assessed using the Medical Outcomes Study Sleep (MOS-Sleep) scale and the Work Productivity and Activity Impairment (WPAI) questionnaire, respectively.
Impact of tildrakizumab on disease severity and PROMs
Tildrakizumab was associated with rapid and sustained reductions in disease severity. Mean PASI scores fell from 11.7 at baseline to 1.43 at week 16 and 0.46 at week 52.
At week 16, 76% of patients achieved PASI 75 and 52% achieved PASI 90. By week 52, PASI 75 and PASI 90 responses increased to 97% and 90%, respectively.
Quality-of-life outcomes improved in parallel. Mean DLQI scores decreased from 8.8 at baseline to 2.73 at week 16 and 1.89 at week 52. DLQI 0/1 was achieved by 70% of patients at week 16 and 80% at week 52.
Pruritus and scaling improved significantly by week 16, whereas pain and sleep disturbance improved more gradually and reached statistical significance only at week 52.
Skindex-16 scores also improved substantially, falling from a mean baseline score of 61.0 to 25.0 at week 16 and 19.3 at week 52.
By contrast, improvements in work productivity, measured using WPAI scores, did not reach statistical significance over the study period.
Correlation analyses demonstrated that PASI improvement closely mirrored improvements in several PROMs during the early treatment phase with tildrakizumab. At week 16, the strongest correlations were observed for pruritus, scaling and DLQI.
Limitations and clinical impact in psoriasis
Although significant associations between PASI and some PROMs persisted at week 52 of tildrakizumab treatment, correlations weakened over time for several measures, including DLQI and pain.
The authors suggested this may reflect a ‘floor effect’, whereby PASI values become uniformly low during long-term maintenance therapy, reducing variability despite ongoing improvements in psychosocial wellbeing and daily functioning.
Repeated-measures analyses nevertheless showed significant within-subject associations between PASI reduction and improvements in DLQI, scaling, pain, pruritus and Skindex-16 over the study period.
The authors noted that sleep quality may be influenced by broader psychosocial and metabolic factors beyond cutaneous inflammation alone, potentially explaining weaker correlations between PASI improvement and MOS-Sleep scores.
Similarly, occupational functioning may depend on wider contextual factors not directly linked to skin severity.
The relatively small sample size, single-centre design and incomplete PROM completion at week 52 were noted as study limitations. However, the prospective longitudinal design and the simultaneous evaluation of clinical and patient-reported outcomes were highlighted as important strengths.
The authors concluded that PASI appears to be a useful marker of early therapeutic response under tildrakizumab treatment, but that PROMs remain essential for capturing the broader long-term patient experience beyond skin clearance alone.
Reference
Facheris P et al. Tildrakizumab improves disease severity and patient-reported outcomes in moderate-to-severe chronic plaque psoriasis: a prospective real-world study. Dermatol Ther (Heidelb) 2026;Apr 24:doi:10.1007/s13555-026-01760-8.
This article was originally published by our sister publication Hospital Healthcare Europe.
