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Therapeutic options for cutaneous psoriasis (and psoriatic arthritis as well) are rapidly expanding. Lancet has published the impressive results of two phase III trials of tildrakizumab, a IgG1 antibody against interleukin 23 p19, in patients with active chronic plaque psoriasis.
Two large randomised controlled studies, reSURFACE 1 and reSURFACE 2 enrolled 2062 adults with moderate-to-severe chronic plaque psoriasis with ≥10% body surface area involvement.
In reSURFACE 1, patients received tildrakizumab 200 mg, tildrakizumab 100 mg, or placebo and in reSURFACE 2 they received tildrakizumab 200 mg, tildrakizumab 100 mg, placebo, or etanercept 50 mg given subcutaneously at weeks 0 and 4 during part 1 of the studies and at week 16 during part 2.
In reSURFACE 1, at week 12, a PASI75 was acheived in 62% in the 200 mg group and 64% in the 100 mg group compared with 6% in the placebo group (p<0·0001 vs placebo).
In reSURFACE 2, a PASI75 was seen 66% in the 200 mg group, 61% in the 100 mg group, and 48% in the etanercept group compared with 6% in the placebo group.
Serious adverse events were similar and low in all groups in both trials, with only one death in reSURFACE 2.
These 2 large trials affirm the efficacy of tildrakizumab (an IL-23 inhibitor) in psoriasis and that responses were superior to placebo and etanercept in moderate-to-severe chronic plaque psoriasis patients.