Plaque Psoriasis in Medicare Patients: Real-World Persistence with Tildrakizumab

In this installment of Discourses in Dermatology, April Armstrong, MD, MPH, reviews a real-world study presented at the American Academy of Dermatology Annual Meeting examining continuity of care among Medicare patients with plaque psoriasis treated with tildrakizumab and other therapeutic classes.

Why this population matters

Older adults with psoriasis represent a clinically complex population. Many patients have longer disease duration, multiple comorbidities, and are managing polypharmacy. These factors, combined with access-related challenges, can make sustained treatment particularly difficult. In this setting, persistence becomes central to long-term disease control.

Psoriasis as a chronic disease: why continuity matters

Psoriasis requires consistent, long-term management. While short-term efficacy is important, real-world continuity over time is often what determines whether patients achieve and maintain control.

For dermatologists, this shifts part of the clinical focus toward understanding how therapies perform outside of controlled trial settings, particularly in populations where adherence and persistence may be harder to maintain.

Study overview: real-world data in an older population

The study reviewed was a large, longitudinal, claims-based analysis including approximately 17,000 patients across multiple treatment classes, including IL-23 inhibitors, IL-17 inhibitors, TNF inhibitors, and PDE-4 inhibitors.  

The analysis specifically focused on a Medicare population with plaque psoriasis. Notably, patients had a Charlson Comorbidity Index of approximately 1.2 to 1.3, reflecting a meaningful comorbidity burden.

The primary objective was to evaluate treatment persistence and time to discontinuation, with a specific focus on tildrakizumab.

Key findings: persistence and time to discontinuation

At 12 months, persistence with tildrakizumab was approximately 70%, compared with roughly 36% to 60% among other therapies evaluated.

At 24 months, more than half of patients remained on tildrakizumab, an important observation in a population where long-term continuity is often difficult to achieve.

Tildrakizumab demonstrated a median time to discontinuation of approximately 29 months, compared with a range of about 7 to 18 months for other therapies.

The role of care delivery and follow-up

One factor highlighted in the discussion is the potential impact of care delivery models. As an in-office, injection-based therapy, tildrakizumab may facilitate more frequent interaction between patients and the health care system.

These built-in touchpoints can support ongoing monitoring, reinforcement of treatment plans, and earlier identification of issues that may lead to discontinuation.

Clinical perspective: reframing treatment goals

These findings contribute to a broader shift in how dermatologists think about therapy selection. The question is not only whether a treatment works, but whether patients are able to remain on therapy over time.

For older adults with psoriasis, durability and persistence become key considerations alongside efficacy and safety. Data like these can help inform upfront decision-making and set more realistic expectations for long-term management.

In a population where treatment discontinuation is common, the level of continuity observed with tildrakizumab may help reframe what sustained management can look like in clinical practice.

Key takeaways

• Medicare patients with psoriasis often face higher clinical complexity, which can make long-term treatment persistence challenging  
• Real-world continuity of care is a critical component of effective psoriasis management  
• In this large claims-based study, tildrakizumab demonstrated higher persistence at 12 and 24 months compared with other treatment classes  
• Median time to discontinuation was longer with tildrakizumab, suggesting greater durability in this population  
• In-office administration may support continuity through more consistent patient follow-up and engagement  
• These findings highlight the importance of considering persistence and long-term use when selecting therapy for older adults with psoriasis