A recent study delved into the nuanced realm of psoriasis management, specifically investigating the potential benefits of tildrakizumab and its role in reducing the occurrence of psoriatic arthritis (PsA). The findings of the study were published in Frontiers in Immunology.
This multi-center, prospective study engaged 246 psoriasis patients who, crucially, had not undergone any systemic therapy or topical finger therapy between January 2020 and April 2023. The study honed in on nailfold capillary (NFC) abnormalities, including nailfold bleeding (NFB) and enlarged capillaries, while also scrutinizing the incidence of new PsA.

The findings revealed a notably more pronounced severity of psoriasis, as gauged by the Psoriasis Area and Severity Index (PASI), in the tildrakizumab group compared to the topical group. However, a compelling revelation surfaced – after seven months of tildrakizumab treatment, individuals aged 65 and older exhibited a significantly superior response to the treatment, achieving PASI clear or PASI 2 or less.
The study explored the quantity and role of regulatory T cells (Tregs) and T helper 17 cells both pre- and post-treatment. Tildrakizumab emerged as a potent influencer, enhancing the number and function of Tregs, which tend to diminish with age. This positive impact extended beyond skin lesions, with the drug demonstrating efficacy in curtailing pathological factors associated with PsA – a noteworthy reduction in NFB, capillary enlargement, and a substantial decrease in the risk of progressing to PsA.
While the study underscores the promising potential of tildrakizumab, especially in the older demographic, discussions around its efficacy stress the need for further exploration. The nuanced interplay between age, immunological response, and PsA progression opens avenues for refined treatment strategies, marking a pivotal moment in the evolving landscape of psoriasis care.
Source:
Fukasawa, T., Yamashita, T., Enomoto, A., Norimatsu, Y., Toyama, S., Yoshizaki-Ogawa, A., Tateishi, S., Kanda, H., Miyagawa, K., Sato, S., & Yoshizaki, A. (2023). The optimal use of tildrakizumab in the elderly via improvement of Treg function and its preventive effect of psoriatic arthritis. In Frontiers in Immunology (Vol. 14). Frontiers Media SA. https://doi.org/10.3389/fimmu.2023.1286251