Tildrakizumab in Psoriatic Patients With Current or Past Malignancy: A Real-Life Cohort and Literature Review

Tildrakizumab has demonstrated high efficacy and a good long-term safety profile, including low malignancy rates, in Phase III trials with 5-year extension. Despite these data, the real-world evidence on patients with psoriasis and a history of cancer is limited.

To assess the efficacy and safety of tildrakizumab in a cohort of patients with moderate-to-severe psoriasis and a previous or current history of neoplasia.

We conducted a retrospective, observational, multicentre study across 27 Spanish dermatology departments. All patients had moderate-to-severe plaque psoriasis and a prior history of an active neoplasia at the time of initiating tildrakizumab treatment.

Forty-eight patients with a mean follow-up period of 50 weeks after initiation of tildrakizumab were included. At Week 24, 82.4% of evaluable patients achieved a Psoriasis Area and Severity Index (PASI) score < 3. By Week 48, 80.0% achieved PASI < 1 and 50.0% reached PASI 0. Twelve patients (25%) began treatment within one year of cancer diagnosis, and four patients started tildrakizumab prior to cancer detection and did not stop treatment. Of the remaining 32, they started tildrakizumab an average of 4.95 years after the cancer diagnosis. Seven patients had active neoplasia at baseline. Overall, 95.8% of the patients did not experience recurrence or worsening of the neoplasia. No adverse events related to tildrakizumab were reported. The cancer state was not considered affected by the psoriasis therapy in any of the cases.

The treatment of moderate to severe psoriasis with tildrakizumab was an effective option, with a safe profile in patients with a history of cancer.