Tildrakizumab in Psoriasis: Adherence, Persistence, and the Role of In-Office Administration

In this video segment, George Han, MD, PhD, explores whether the site of biologic administration meaningfully influences adherence, persistence, and long-term outcomes in plaque psoriasis. Using tildrakizumab as a real-world case study, he reframes in-office administration from a perceived inconvenience into a potential clinical advantage, supported by emerging adherence and persistence data.

At the heart of the discussion is a familiar tension in psoriasis care: most biologics are self-administered at home, but does administration site actually matter when it comes to keeping patients on therapy and maintaining durable disease control?

Adherence: removing the guesswork

Dr Han emphasizes a reality dermatology providers see often: for most patients, starting a biologic for psoriasis is a long-term, often lifelong, commitment. While patients may achieve clearance and feel confident early on, interruptions in therapy are common. When biologics are stopped, relapse is typical, and when the same drug is restarted, it may not work as well as before, potentially due to anti-drug antibodies or other factors.

This creates a clinical challenge. When medications are self-administered at home, missed or misfired doses may not come to light until disease worsens. In contrast, in-office administration gives providers confidence in when and how doses are delivered, with clear documentation and fewer unknowns.

That clarity becomes especially important when a patient is not responding as expected. Is the issue loss of efficacy, or was adherence inconsistent? In-office dosing removes one major variable from that equation.

Persistence: staying on therapy long term

Dr Han distinguishes adherence from persistence, noting that persistence refers to how long a patient remains on a given therapy. Despite consistent counseling on the importance of staying on biologics, real-world data suggest that approximately half of patients discontinue treatment within one to two years.1,2

Persistence matters clinically and economically. Switching biologics increases the risk of adverse effects and is costly, with first-year biologic expenses typically higher than subsequent years. From both a patient-care and practice perspective, keeping patients on an effective therapy is a priority.

Across treatment classes, persistence challenges remain. Studies show that oral systemic therapies fare only modestly better, with adherence around 58%, and more than half of patients discontinuing within 6 months,3,4 often due to tolerability issues such as gastrointestinal side effects or headaches, based on Dr Han’s clinical experience.

In-office administration as a clinical advantage

Dr Han highlights real-world data on tildrakizumab, an IL-23 inhibitor indicated for health care provider administration. In observational studies, more than half of patients remained on therapy at 12 months, with a median time to discontinuation of approximately 22 months, alongside high adherence rates.5

He suggests that in-office administration plays a meaningful role. Scheduled visits allow practices to proactively manage logistics, coordinate access and paperwork, send reminders, and ensure doses are administered correctly and on time. This infrastructure supports adherence while reducing the burden on patients who may be hesitant, forgetful, or uncomfortable with self-injection.

Dr Han also notes the opportunity to maximize these visits by pairing injections with skin exams or disease check-ins, improving continuity of care. For patients with prior suboptimal responses, in-office dosing removes uncertainty and allows providers to focus on true treatment efficacy rather than adherence concerns.

A broader perspective

Dr Han concludes by emphasizing that the expanding psoriasis armamentarium has meaningfully improved clearance rates, durability, and quality of life for patients. As clinicians, the goal is not only to select an effective therapy, but also to choose a delivery model that aligns with patient behavior and real-world needs.

For patients who struggle with self-administration or consistency, bringing treatment into the office can be a practical, patient-centered strategy to support adherence, persistence, and long-term outcomes.

Key takeaways

• Adherence and persistence remain major challenges in psoriasis care, regardless of treatment class
• In-office administration removes uncertainty around dosing and helps clarify whether lack of response reflects adherence or true treatment failure
• Real-world data on tildrakizumab suggest strong adherence and persistence, potentially supported by clinician-administered dosing and structured follow-up
• For patients who struggle with self-injection or consistency, in-office administration can be a practical strategy to support durable long-term outcomes

References:

1. Doshi JA, Takeshita J, Pinto L, et al. Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population. J Am Acad Dermatol. 2016;74(6):1057-1065.e4. doi:10.1016/j.jaad.2016.01.048
2. Yeung H, Wan J, Van Voorhees AS, et al. Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis. J Am Acad Dermatol. 2013;68(1):64-72. doi:10.1016/j.jaad.2012.06.035
3. Das AK, Chang E, Paydar C, Broder MS, Orroth KK, Cordey M. Apremilast Adherence and Persistence in Patients with Psoriasis and Psoriatic Arthritis in the Telehealth Setting Versus the In-person Setting During the COVID-19 Pandemic. Dermatol Ther (Heidelb). 2023;13(9):1973-1984. doi: 10.1007/s13555-023-00967-3. Erratum in: Dermatol Ther (Heidelb). 2023 Sep;13(9):1985. doi: 10.1007/s13555-023-00984-2. PMID: 37392261; PMCID: PMC10442297.
4. Schmidt L, Wang CA, Patel V, et al. Early Discontinuation of Apremilast in Patients with Psoriasis and Gastrointestinal Comorbidities: Rates and Associated Risk Factors. Dermatol Ther (Heidelb). 2023;13(9):2019-2030. doi:10.1007/s13555-023-00975-3
5. Han G, Zanardo E, Simpson R, et al. Treatment patterns in patients with moderate-to-severe psoriasis treated with biologics. Poster presented at: American Academy of Dermatology Annual Meeting; March 2025; Orlando, FL.