Tildrakizumab in the treatment of moderate-to-severe plaque psoriasis: expert insights from Italian real-world experience

Introduction: Tildrakizumab, a selective interleukin (IL)-23 p19 inhibitor, is an established treatment for moderate-to-severe plaque psoriasis. However, clinical trials are characterized by strict eligibility criteria, which often prevent the recruitment of patients with complex real-world conditions. This review summarizes Italian real-world experience providing critical information for optimizing the use of tildrakizumab in clinical practice, ultimately improving patient outcomes. Areas covered: A literature search was performed in PubMed for real-world studies of tildrakizumab conducted in Italy and published between May 2020 and January 2025. The selected articles reported here provide an overview of the safety and effectiveness of tildrakizumab in real-world in clinically challenging subgroups, including patients with comorbidities, high‑impact area involvement, prior biologic exposure, obesity, and advanced age. Expert opinion: Real‑world evidence from Italy consistently confirms that tildrakizumab provides durable effectiveness and a favorable safety profile across a broad spectrum of patients, often matching or exceeding outcomes reported in pivotal trials. The availability of two approved dosing options may support personalized treatment approaches, although current evidence remains observational and further long-term studies are required to define the full clinical implications.