Tildrakizumab

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.