A Delphi Consensus on Tildrakizumab Dosing and Titration in Moderate-to-Severe Plaque Psoriasis

Tildrakizumab is approved for moderate-to-severe plaque psoriasis in 2 doses, 100 mg and 200 mg, with comparable safety profiles. This study aimed to establish pan-European consensus on optimal tildrakizumab dosing and titration using a modified Delphi methodology. A steering group of 8 European dermatologists developed 48 consensus statements addressing tildrakizumab prescribing, dose selection and titration. The statements were incorporated into an online Likert survey and distributed across 9 European countries to experienced dermatologists. Consensus was predefined as ≥75% agreement. Seventy-two dermatologists completed the survey. Consensus was achieved for 35/48 statements (73%). Based on the results, initiation with the 100 mg dose may be considered in patients weighing <90 kg with a body mass index <25, moderate disease severity or who are biologic-naïve. Initiation with the 200 mg dose may be considered in patients weighing ≥90 kg and/or with a body mass index ≥25, severe disease, high-impact area involvement in the context of severe disease, prior interleukin-23p19 inhibitor failure or failure of ≥2 biologics. Up-titration to 200 mg may be considered for suboptimal response, while down-titration to 100 mg may be considered after ≥1 year of sustained remission. Adoption of this guidance may facilitate more consistent, individualized dosing and improved patient outcomes.