Abstract
Tildrakizumab, a humanized monoclonal antibody targeting the p19 subunit of interleukin-23, has demonstrated durable efficacy and a favorable long-term safety profile in moderate-to-severe plaque psoriasis. However, patients encountered in clinical practice frequently have comorbidities, treatment barriers, and social circumstances that are underrepresented in randomized clinical trials. This case review describes 16 patients treated with tildrakizumab across clinically relevant populations, including older adults, patients with cardiometabolic disease or complex medical comorbidities, and individuals with unique treatment considerations. Across these cases, tildrakizumab was associated with substantial improvement in psoriasis, including involvement of high-impact sites such as the scalp, nails and intertriginous regions. Durable disease control was observed in patients with prior malignancy, chronic infection, hepatic disease, cardiovascular comorbidities, polypharmacy, and prior biologic failure, without treatment-limiting adverse events attributed to tildrakizumab. In-office administration and every-12-week maintenance dosing also offered practical advantages for patients facing Medicare-related access considerations, self-injection aversion, inconsistent healthcare access, or adherence challenges. These cases demonstrate how tildrakizumab may be integrated into individualized psoriasis management and highlight its potential as a practical, effective, and well-tolerated treatment option across diverse real-world clinical settings.