Real‐World Effectiveness of Tildrakizumab in Biologic‐Naive Plaque Psoriasis: A Case Series

Background Tildrakizumab is a selective interleukin‐23 p19 inhibitor approved for moderate‐to‐severe plaque psoriasis. Real‐world data, specifically in biologic‐naive patients, remains limited. Objectives To evaluate the real‐world effectiveness and safety of tildrakizumab 100 mg in biologic‐naive patients with moderate‐to‐severe plaque psoriasis. Methods Retrospective case series of 20 consecutive biologic‐naive adult patients with moderate‐to‐severe plaque psoriasis treated with tildrakizumab 100 mg at weeks 0, 4 and every 12 weeks thereafter at a single Canadian dermatology practice between 2022 and 2025. All analyses were conducted on an as‐observed basis with no imputation for missing data. Efficacy was assessed using Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) and Dermatology Life Quality Index (DLQI). Safety was monitored through adverse event documentation. Results The cohort included 13 males (65%) and 7 females (35%) with a mean age of 51.4 years, a mean disease duration of 7.8 years (range 0.5 to 50), and 50% obesity prevalence. Mean baseline PASI was 22.1 (SD 9.8), BSA 48.9% (SD 18.4) and DLQI 20.6 (SD 5.0; n = 11). At the first evaluable post‐baseline visit (median 12 weeks; range 4 to 16), 100% of evaluable patients (19/19) achieved PASI 75 and PASI 90, while 89.5% (17/19) achieved PASI 100. Mean PASI decreased to 0.3 (98.7% reduction). No adverse events were documented during a mean treatment duration of 82.6 weeks, and no patients discontinued treatment. Limitations Interpretation is limited by sample size, variable follow‐up timing and retrospective design. Conclusions In this small retrospective biologic‐naive cohort, tildrakizumab showed high effectiveness and favourable tolerability.