reSURFACE 1 and reSURFACE 2 post hoc analysis: Tildrakizumab in patients with early- vs late-onset plaque psoriasis

Interleukin (IL)-23 p19 antibodies are used in the treatment of moderate-to-severe plaque psoriasis. However, there is limited evidence on the impact of anti-IL-23 p19 antibodies on the treatment of early- vs late-onset disease. Tildrakizumab, an anti-IL-23 p19 antibody, is approved for the treatment of moderate-to-severe plaque psoriasis. Armstrong et al. published a post hoc analysis of the phase III reSURFACE1 (NCT01722331) and reSURFACE2 (NCT01729754) trials evaluating the efficacy and safety of tildrakizumab in patients with moderate-to-severe plaque psoriasis in the British Journal of Dermatology.¹

Patients were grouped by age of psoriasis onset into early-onset (n = 111) and late-onset (n = 130). Efficacy outcomes included absolute PASI and proportion of patients achieving PASI <5, <3, <1, 100, 90, 75, DLQI, DLQI 0/1, and PGA 0/1 through 28 weeks. Safety outcomes were TEAEs and serious TEAEs.

Key learnings

A higher proportion of patients in the late- vs early-onset group achieved absolute PASI <1 (36.2% vs 27.9%; p = 0.0118), PASI 100 (21.5% vs 8.1%; p = 0.0006), and PASI 90 (50.8% vs 39.6%; p = 0.0033).

Age of psoriasis onset did not affect change from baseline in absolute PASI (p = 0.9856), DLQI (p = 0.2377), achievement of PASI <5 (p = 0.4798), PASI <3 (p = 0.4015), PASI 75 (p = 0.3938), DLQI 0/1 (p = 0.2377), or PGA 0/1 (p = 0.8729).

TEAEs occurred in 65.8% vs 66.2% of patients in the early- vs late-onset psoriasis groups, while serious TEAEs occurred in 3.6% vs 6.9% of patients, respectively.

Tildrakizumab was effective in both groups, with no new safety signals observed. Patients with late- vs early-onset psoriasis achieved complete or near-complete clearance. Tildrakizumab may present a viable treatment option for older patients with psoriasis.