Is Tildrakizumab Monotherapy Effective In Treating Moderate to Severe Plaque Psoriasis?

Objective: The objective of this selective EBM review is to determine whether or not tildrakizumab monotherapy is effective in treating moderate to severe plaque psoriasis. Study Design: Systemic review of three randomized placebo controlled clinical trials published in 2015 and 2017. Data Sources: Three randomized controlled trials published in peer-reviewed journals comparing the effects of IV or subcutaneous tildrakizumab to a visually matched placebo for the treatment of moderate to severe plaque psoriasis. Data sources were found using the PubMed database. Outcomes Measured: The reduction of psoriatic lesions following treatment was measured using the Psoriasis Area and Severity Index 75 (PASI 75) through visual evaluation of patients by investigators. Results: All three studies demonstrated a reduction in psoriatic lesions with the use of tildrakizumab. PASI 75 measured at week 12 or 16 showed an approximate 60% absolute benefit increase with tildrakizumab versus visually matched placebo. This resulted in a NNT of 2 for all studies. Conclusions: All three studies illustrated that tildrakizumab is effective as monotherapy for moderate to severe plaque psoriasis in adults. While this is true, study sample sizes were relatively small and patient demographics were not representative to the general population. Further studies are needed to compare tildrakizumab to other biological medications that are more widely used