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Early PASI Score Can Identify Nonresponders to Tildrakizumab for Patients with Moderate to Severe Psoriasis

A recent study aimed to evaluate whether early Psoriasis Area Severity Index (PASI) improvements can predict week 28 tildrakizumab responders and nonresponders.

Published in Journal of Dermatological Treatment, the study pooled patients with psoriasis from two tildrakizumab phase 3 trials and randomized them to receive tildrakizumab 100 mg at weeks 0, 4, 16, and 28. These patients were grouped by week 28 PASI responses (<50, 50-74, 75-89, and 90-100) with PASI improvements from baseline at weeks 4 and 16 analyzed for each response group.

The authors noted that of the 575 patients included, 8.3%, 14.3%, 23.8%, and 53.6% achieved PASI <50, 50-74, 75-89, and 90-100, respectively, by week 28. Of patients with PASI <50 at week 16, 85% did not achieve PASI ≥75 at week 28 (nonresponders). Rapid response was defined as PASI ≥50 at week 4 (after a single tildrakizumab dose) and observed in 41% of patients. Within these patients, 87% were week 28 responders (PASI ≥75) while 67% were "super responders" (PASI 90-100). Finally, among week 28 responders and super responders, 45% and 50%, respectively, achieved PASI ≥50 at week 4.

The study concluded that these nonresponders to tildrakizumab at week 28 can be identified by week 16 PASI response and, further, that the PASI improvements from as early as week 4 can predict patients' week 28 PASI improvement status. —Jessica Garlewicz

Feldman SR, Merola JF, Pariser DM, et al. clinical implications and predictive values of early PASI responses to tildrakizumab in patients with moderate-to-severe plaque psoriasis. J Dermatolog Treat. Published online March 8, 2021. doi:10.1080/09546634.2021.1898528

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