Long-Term Persistence With Tildrakizumab in Real-World Practice

Real-world persistence data for tildrakizumab paint an encouraging picture of long-term treatment durability, with approximately 70% of patients remaining on therapy at 1 year and a median treatment duration exceeding 2 years. These figures are broadly consistent with what has been observed for IL-23 and IL-17 class agents generally, reflecting the sustained immunologic efficacy that has made these targeted biologics the backbone of moderate-to-severe psoriasis management.

However, interpreting persistence data requires careful consideration of factors beyond clinical response alone. For tildrakizumab in particular, its use in the Medicare and Medicaid population via the buy-and-bill reimbursement model creates a unique dynamic: because it can be covered under hospitalization benefits—unlike most other IL-23 agents—it becomes a cost-effective option for a patient group with limited alternatives. This coverage advantage may contribute to longer treatment duration, as clinicians and patients face fewer incentives to switch to a different agent.

The possibility of prescriber-level influences also merits acknowledgment. Providers who buy and bill for a medication may, in some cases, be slower to transition patients away from a product due to financial considerations—a dynamic that underscores the importance of interpreting persistence data within their full context.

Despite these nuances, the real-world durability of tildrakizumab and other IL-23 agents broadly reflects their genuine clinical value. High rates of sustained skin clearance, infrequent dosing schedules, and favorable safety profiles all contribute to patient willingness to remain on therapy long-term. These data reinforce the role of IL-23 inhibitors as reliable, long-term treatment options for patients with moderate-to-severe psoriasis.

Reference:

Lockshin B, Beeghly A, Blachley T, Eliot M, Barghout V, Mathew J, Ferro T, Prajapati VH. Real-world tildrakizumab persistence in the US by biologic experience and insurance coverage in the PPD CorEvitas Psoriasis Registry. Poster presented at: Winter Clinical Dermatology Conference; January 16-21, 2026; Maui, Hawaii.