Anti-IL-23p19 monoclonal antibody Pregnancy: As a precautionary measure it is preferable to avoid use during pregnancy — there are no or limited data (fewer than 300 pregnancy outcomes); animal studies do not indicate reproductive toxicity. Women of childbearing potential should use an effective method of contraception during treatment and for at least 17 weeks after treatment. Breast-feeding: it is unknown whether tildrakizumab is excreted in human milk — a risk to newborns cannot be excluded in the first few days after birth.

Tildrakizumab

Brand names: Ilumetri

Tildrakizumab is a humanised monoclonal antibody targeting the p19 subunit of interleukin-23, used for moderate-to-severe plaque psoriasis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 100 mg

Route: Subcutaneous injection

Frequency: Weeks 0 and 4, then every 12 weeks thereafter

Plaque psoriasis; for use under the guidance and supervision of a physician experienced in its diagnosis and treatment. At the physician's discretion, a dose of 200 mg may provide greater efficacy in patients with a high disease burden or in patients above 90 kg body weight. Consideration should be given to discontinuing treatment in patients who have shown no response after 28 weeks; some patients with an initial partial response may subsequently improve with continued treatment beyond 28 weeks. Missed dose: administer as soon as possible, then resume dosing at the regular scheduled time. Elderly: no dose adjustment required. PAEDIATRIC: safety and efficacy in children and adolescents below 18 years have not yet been established — no data are available, and no paediatric dose is stated. Administration: alternate injection sites; do not inject into areas where the skin is affected by plaque psoriasis or is tender, bruised, red, hard, thick or scaly. Do not shake the syringe or pen; each syringe or pen is for single use only. Patients may self-inject after proper training if the physician determines it appropriate, with appropriate follow-up. Evaluate patients for tuberculosis infection before starting treatment.

Dose adjustments

Renal

Not studied in renal or hepatic impairment — no dose recommendations can be made.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Clinically important active infection, e.g. active tuberculosis

Side effects

Upper respiratory tract infections (including nasopharyngitis) — very common, 12.6%
Headache — common, 4.0%
Diarrhoea (1.6%) and gastroenteritis (1.5%) — common
Back pain — common, 1.5%
Nausea — common, 1.3%
Injection site pain — common, 1.3%

Interactions

Live vaccines should not be given concurrently; wait at least 4 weeks after a live viral or bacterial vaccination before starting tildrakizumab, and avoid live vaccines during treatment and for at least 17 weeks after it. No data are available on the response to live or inactivated vaccines
No cytochrome P450 interactions are expected — tildrakizumab is cleared by general protein catabolism, and it does not affect the pharmacokinetics of concomitant medicines metabolised by CYP450 enzymes
The safety and efficacy of tildrakizumab in combination with other immunosuppressive agents, including biologics, or with phototherapy has not been established

Clinical monograph

How it works

It selectively binds the p19 subunit of interleukin-23, blocking IL-23-driven differentiation and activation of T-helper 17 cells and the downstream inflammation that produces psoriatic plaques.

Prescribing in practice

Screen for active and latent tuberculosis and exclude clinically important active infection before starting treatment.
Avoid initiation during a serious active infection and treat infections that arise during therapy.
Avoid live vaccines during treatment.

Monitoring

No mandatory routine laboratory monitoring is required; monitor clinically for infection and assess psoriasis response to guide continuation.

Counselling the patient

Treatment is given by subcutaneous injection, typically every few months after initial doses.
Report signs of infection such as fever or persistent cough.
Tell clinicians you are on this medicine before receiving any vaccinations.

Evidence & guidelines

NICE recommends tildrakizumab for severe plaque psoriasis, with efficacy demonstrated in the reSURFACE 1 and 2 trials.

Reference: NICE TA575; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Mirikizumab · Anti-IL-23p19 monoclonal antibody

Pathways