Tildrakizumab in real-world Chinese psoriasis: efficacy-safety profiles from a 28-week retrospective cohort with geriatric, late-onset and metabolic syndrome stratification

To assess the real-world efficacy and safety of tildrakizumab in Chinese patients with psoriasis stratified by age, age of psoriasis onset and MetS status. This two-center retrospective cohort study evaluated tildrakizumab’s efficacy and safety over 28 weeks in 80 Chinese adults with moderate-to-severe plaque psoriasis, with subgroup analyses by age and age of psoriasis onset and metabolic syndrome (MetS). Mean PASI scores showed progressive improvement, declining from 9.3 ± 5.1 at baseline to 1.0 ± 1.4 at week 28 (p < 0.001). A high proportion of patients responded by week 16 (78.4% achieving PASI ≤ 3; 48.6% PASI ≤ 1), with further improvement at week 28 (88.6% and 62.0%, respectively). Dermatology Life Quality Index (DLQI) scores paralleled clinical gains, decreasing from 7.7 ± 4.6 to 0.9 ± 1.8 (p < 0.001), reflecting an 88.3% reduction in quality-of-life impairment. Geriatric patients showed superior PASI 100 responses (81.8% vs 38.6%, p < 0.001) while late-onset patients also represented higher PASI 90 responses (81.5% vs 55.8%, p = 0.027) at week 28. The MetS status did not affect therapeutic response (PASI 100 response: 52.6% vs 45.5%, p = 0.622) at week 28. Safety monitoring identified 4 (5.0%) treatment-emergent adverse events, with no treatment discontinuation for psoriasis exacerbation. Tildrakizumab demonstrated sustained efficacy in real-world management of moderate-to-severe psoriasis and supported broad applicability across diverse psoriasis subtypes.