10.5826/dpc.1304a215
Introduction: Tildrakizumab is a humanized IgG1κ monoclonal antibody targeting the p19 subunit of interleukin (IL)-23, approved in 2018 for the treatment of patients with moderate-to-severe chronic plaque psoriasis.
Objectives: This study aimed to evaluate the effectiveness, safety and survival of tildrakizumab in the medium term (48 weeks) in psoriatic patients failure to previous biologic treatment in a real world setting.
Methods: This was a retrospective, multicenter observational study that included adult patients with moderate-to-severe plaque psoriasis, failure to previous biologic therapy, consecutively treated with tildrakizumab. PASI and BSA values were recorded at baseline, at 12 and 48 weeks of treatment. Safety and tolerability of tildrakizumab were investigated by examining the presence of any adverse events.
Results: Overall 51 patients were enrolled. Baseline disease severity was moderate to severe with a mean PASI score of 19.2 ± 8.5, mean BSA of 16 ± 10.4, and mean DLQI of 18.2 ± 6.8. A significant reduction in the mean PASI score was detected at 12 weeks of tildrakizumab therapy (3.5 ± 2.7, p &lt; 0.001), with a further improvement at week 48 (0.6 ± 1.5, p &lt; 0.001). At week 12, there was a great improvement in BSA score for all groups (p &lt;0.001) with further increase at week 48. The effectiveness was confirmed also by DLQI assessment, with a significant decrease at week 12 and even more at week 48 (p &lt;0.001).
Conclusions: This study confirms the effectiveness of tildrakizumab in daily clinical practice in patients with moderate-to-severe plaque psoriasis.
text/xml
2160-9381
3114
en
Anna Balato
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
anti-IL-23 monoclonal antibody
Effectiveness and Safety After a Switch to Tildrakizumab: A Real World Multicenter Italian Study in Psoriasis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-10-31
2022-12-24
2023-10-31
2024-01-15
e2023215
Dermatol Pract Concept
Introduction: Tildrakizumab is a humanized IgG1κ monoclonal antibody targeting the p19 subunit of interleukin (IL)-23, approved in 2018 for the treatment of patients with moderate-to-severe chronic plaque psoriasis.
Objectives: This study aimed to evaluate the effectiveness, safety and survival of tildrakizumab in the medium term (48 weeks) in psoriatic patients failure to previous biologic treatment in a real world setting.
Methods: This was a retrospective, multicenter observational study that included adult patients with moderate-to-severe plaque psoriasis, failure to previous biologic therapy, consecutively treated with tildrakizumab. PASI and BSA values were recorded at baseline, at 12 and 48 weeks of treatment. Safety and tolerability of tildrakizumab were investigated by examining the presence of any adverse events.
Results: Overall 51 patients were enrolled. Baseline disease severity was moderate to severe with a mean PASI score of 19.2 ± 8.5, mean BSA of 16 ± 10.4, and mean DLQI of 18.2 ± 6.8. A significant reduction in the mean PASI score was detected at 12 weeks of tildrakizumab therapy (3.5 ± 2.7, p &lt; 0.001), with a further improvement at week 48 (0.6 ± 1.5, p &lt; 0.001). At week 12, there was a great improvement in BSA score for all groups (p &lt;0.001) with further increase at week 48. The effectiveness was confirmed also by DLQI assessment, with a significant decrease at week 12 and even more at week 48 (p &lt;0.001).
Conclusions: This study confirms the effectiveness of tildrakizumab in daily clinical practice in patients with moderate-to-severe plaque psoriasis.
Anna Balato
2023/10/31
10.5826/dpc.1304a215
e2023215
Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
2160-9381
anti-IL-23 monoclonal antibody
en
e2023215
Graier1 T, Weger W, Jonak C, et al. Real world effectiveness of anti interleukin 23 antibodies in chronic plaque type psoriasis of patients from the Austrian Psoriasis Registry (PsoRA). Sci Rep. 2022;12(1):15078. doi: 10.1038/s41598-022-18790-9.
Effectiveness and Safety After a Switch to Tildrakizumab: A Real World Multicenter Italian Study in Psoriasis
https://dpcj.org/index.php/dpc/article/download/3114/2369
        Effectiveness and Safety After a Switch
  to Tildrakizumab: A Real World Multicenter Italian
                   Study in Psoriasis
          Eugenia Veronica Di Brizzi1, Dario Buononato1, Pierfrancesco Benvenuto1,
     Giuseppe Argenziano1, Rocco De Pasquale2, Carmen Silvia Fiorella3, Claudia Giofrè4,
       Maria Letizia Musumeci2, Giovanni Palazzo5, Leonardo Zichichi6, Anna Balato1


1 Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
2 U.O.C. Dermatology Unit, “G. Rodolico-S. Marco” Hospital, Catania, Italy
3 Dermatology Unit, “Monsignor Raffaele Dimiccoli” Hospital, Barletta, Italy
4 U.O.C. Dermatology Unit, “Papardo” Hospital, Messina, Italy
5 Dermatology Unit, Hospital of Tinchi Pisticci, Italy
6 U.O.C. Dermatology Unit, “S. Antonio Abate” Hospital, Trapani, Italy



Key words: Psoriasis, tildrakizumab, biologic drug, anti IL-23 monoclonal antibody
Citation: Di Brizzi EV, Buononato D, Benvenuto P, et al. Effectiveness and Safety After a Switch to Tildrakizumab: a Real World Multicenter
Italian Study in Psoriasis. Dermatol Pract Concept. 2023;13(4):e2023215. DOI: https://doi.org/10.5826/dpc.1304a215
Accepted: April 21, 2023; Published: October 2023
Copyright: ©2023 Di Brizzi et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Eugenia Veronica Di Brizzi, MD, ; Dermatology Unit, University of Campania Luigi Vanvitelli,
Nuovo Policlinico (edificio 9C), Via Pansini 5, 80131 Naples Italy. E-mail: eugeniaveronica.dibrizzi@gmail.com




  ABSTRACT             Introduction: Tildrakizumab is a humanized IgG1κ monoclonal antibody targeting the p19 subunit
                       of interleukin (IL)-23, approved in 2018 for the treatment of patients with moderate-to-severe chronic
                       plaque psoriasis.
                       Objectives: This study aimed to evaluate the effectiveness, safety and survival of tildrakizumab in the
                       medium term (48 weeks) in psoriatic patients failure to previous biologic treatment in a real world
                       setting.
                       Methods: This was a retrospective, multicenter observational study that included adult patients with
                       moderate-to-severe plaque psoriasis, failure to previous biologic therapy, consecutively treated with
                       tildrakizumab. Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) values were recorded
                       at baseline, at 12 and 48 weeks of treatment. Safety and tolerability of tildrakizumab were investigated
                       by examining the presence of any adverse events.
                       Results: Overall 51 patients were enrolled. Baseline disease severity was moderate to severe with a
                       mean PASI score of 19.2 ± 8.5, mean BSA of 16 ± 10.4, and mean Dermatology Life Quality Index



Original Article | Dermatol Pract Concept. 2023;13(4):e2023215                                                                           1
                      (DLQI) of 18.2 ± 6.8. A significant reduction in the mean PASI score was detected at 12 weeks of
                      tildrakizumab therapy (3.5 ± 2.7, P < 0.001), with a further improvement at week 48 (0.6 ± 1.5, P <
                      0.001). At week 12, there was a great improvement in BSA score for all groups (P <0.001) with further
                      increase at week 48. The effectiveness was confirmed also by DLQI assessment, with a significant
                      decrease at week 12 and even more at week 48 (P <0.001).
                      Conclusions: This study confirms the effectiveness of tildrakizumab in daily clinical practice in pa-
                      tients with moderate-to-severe plaque psoriasis.




Introduction                                                        Inclusion criteria were age ≥ 18 years, concomitant
                                                                 presence of moderate-to-severe psoriasis (Psoriasis Area Se-
Psoriasis is a chronic immune-mediated disease with the          verity Index [PASI] ≥ 10), failure to previous biologic ther-
IL-23/IL-17 axis playing the leading role [1].                   apy. Failure was defined as the loss of at least PASI 50. A
    Tildrakizumab is a humanized IgG1κ monoclonal an-            washout period of at least 4 weeks from previous systemic
tibody targeting the p19 subunit of interleukin (IL)-23,         treatments was required. Exclusion criteria were hepatitis
approved in 2018 for the treatment of patients with              B surface Ag positive, hepatitis C Ab positive, active tu-
moderate-to-severe chronic plaque psoriasis [2]. The effec-      berculosis (TB) or history of incompletely treated TB, ma-
tiveness and safety of tildrakizumab has been firstly eval-      lignancy or history of malignancy in the last 5 years. After
uated in a phase 2b randomized placebo-controlled trial          appropriate screening tests, tildrakizumab was adminis-
and in two randomized phase 3 clinical trials, compared          tered in monotherapy at the standard dose regimen (induc-
with both placebo (reSURFACE 1 and 2) and etanercept             tion phase: 100 mg subcutaneously at weeks 0 and 4, and
­(reSURFACE 2). Tildrakizumab has been also well-tolerated,      a maintenance dose every 12 weeks thereafter). Data col-
showing no safety issues although the discrete higher risk of    lected included demographic data (eg, age, gender, height,
nasopharyngitis [3,4]. Recently, confirmatory data on effi-      weight and body mass index [BMI]), disease duration (de-
cacy and safety derived from real-world studies in patients      fined as the time from diagnosis to start of tildrakizumab
affected by psoriasis, also involving difficult-to-treat areas   treatment), associated comorbidities and previous systemic,
as scalp, nail, palmoplantar and genital psoriasis are avail-    including biological therapies.
able [5-10].
    Nevertheless, little evidence is currently available about   Outcome Measures
the impact of previous biologic exposure on subsequent           PASI and Body Surface Area (BSA) values were recorded at
treatment with tildrakizumab, unlike other biologics [11,12]     baseline (prior to treatment with tildrakizumab) at 12 and
not allowing dermatologists to maximize patient therapeu-        48 weeks of treatment. The effectiveness of tildrakizumab
tic management after switching within and between classes.       was reported as the absolute PASI score as well as the rela-
Hence, this multicenter retrospective study aimed to evaluate    tive percentage of patients achieving 75%, 90%, and 100%
the effectiveness, safety and survival of tildrakizumab in the   improvement from baseline PASI (PASI 75, PASI 90, and
medium term (48 weeks) in psoriatic patients failure to pre-     PASI 100, respectively) at 12 and 48 weeks. The impact on
vious biologic treatment in a real world setting.                patients quality of life (QoL) was assessed through Derma-
                                                                 tology Life Quality Index (DLQI) at each visit (baseline,
Methods                                                          weeks 12 and 48).

Study Design, Patients Characteristics and Data                  Safety
Collection                                                       Safety and tolerability of tildrakizumab were investigated
This was a retrospective, multicenter observational study        by examining the presence of any adverse events (AEs),
that included adult patients with moderate-to-severe plaque      including mild and serious AEs, laboratory values (hema-
psoriasis consecutively treated with tildrakizumab at seven      tology, clinical chemistry and urinalysis), physical exam-
Italian Dermatology Units with psoriasis-specialized units.      ination and local tolerability. The occurrence of AEs was
The study was performed in accordance with the principles        collected at weeks 12 and 48. Reasons for tildrakizumab
of the Helsinki Declaration and informed written consent         withdrawal were also collected and classified as (i) lack or
has been obtained from the patients for the use of retrospec-    loss of efficacy; (ii) AEs; and (iii) other reasons (lost to fol-
tive data collected during routine clinical practice.            low-up, etc)


2                                                                    Original Article | Dermatol Pract Concept. 2023;13(4):e2023215
Statistical Analysis                                                         Table 1. Demographic and baseline
Patient demographics, clinical characteristics, and primary                characteristics of the study population.
outcome measures at the baseline visit were summarized us-                                               All patients (N = 51)
ing descriptive statistics. Descriptive data were reported us-              Characteristics             [N (%) or mean ± SD]
ing frequencies and percentage for categorical variables and        Demographics
mean values ± standard deviation for continuous ones.               Male                                            39 (76.5)
    The Wilcoxon matched pairs signed rank test was used            Age (years)                                    52.3± 14.7
for continuous variables at different scheduled visits. Uni-
                                                                    Weight (kg)                                    82.6± 16.9
variate regression analysis was conducted to evaluate the
                                                                    BMI (kg/m2)                                    29.8± 11.9
relationship between the variables age, obesity, gender, pre-
                                                                    BMI >30                                         14 (27.5)
vious use of biological treatment (anti-TNFα, anti-IL17,
                                                                    Difficult-to-treat locations
anti-IL12/23) and tildrakizumab clinical efficacy expressed
                                                                    Genital                                         12 (23.5)
in terms of PASI, BSA and DLQI values. A P value less than                                                          19 (37.3)
                                                                    Scalp
0.05 was considered statistically significant. Statistical anal-    Nails                                           15 (29.4)
yses were computed using GraphPad Prism 6.0 (GraphPad               Palmar/plantar                                   8 (15.7)
Software Inc.) and SAS® software version 9.3 (SAS Insti-            Comorbidities
tute Inc.).
                                                                    Yes                                             34 (66.7)
                                                                    Diabetes mellitus                               8 (15.7)
Results                                                             Dyslipidemia                                    17 (33.3)
                                                                    Hypertension                                    24 (47.1)
Overall, 51 patients were enrolled; most were male (76.5%,
                                                                    Cardiopathy                                     11 (21.6)
39/51) with a mean age at the time of starting tildrakizumab
of 52.3 ± 14.7 years (Table 1). Baseline disease severity was       Other

moderate to severe with a mean PASI score of 19.2 ± 8.5,            Psoriatic arthritis
mean BSA of 16 ± 10.4, and mean DLQI of 18.2 ± 6.8.                 Yes                                             9 (17.6)
Mean body mass index (BMI) was 29.8 ± 11.9 kg/m , and       2       Age of onset (years)                           53.2± 11.4
27.5% (14/51) of patients were obese (BMI ≥ 30). Comorbid           Duration of disease (years)                    10.4± 9.7
conditions were reported in 66.7% (34/51) of patients. In           Psoriasis
particular, 17.6% (9/51) were affected by psoriatic arthritis       Age of onset (years)                           22.9± 10.3
(PsA) with the mean disease duration of 10.4 ± 9.7, the base-       Duration of disease (years)                    21.7± 10.9
line disease severity was measured as DAS 28 of 4.9 ± 5.2;          PASI                                           19.2± 8.5
patients were not doing other arthritis therapies other than        BSA                                             16± 10.4
tildrakizumab. Hypertension and dyslipidemia were among             DLQI                                           18.2± 6.8
the most frequent comorbidities. Regarding previous sys-
                                                                    Previous therapies
temic therapy, and in particular conventional non-biologic          Phototherapy                                       28
one, the majority of patients were treated with cyclosporine.       Cyclosporine                                       43
Obviously, all patients have been administered at least 1 bio-      Methotrexate                                       19
logic drug, since this represented an inclusion criterion. Fur-     Acitretin                                          16
                                                                    Anti-TNF                                           44
thermore, 54.9% (28/51) of patients had already received at
                                                                    Anti-IL-17                                         18
least 2 biologic treatments. The most common biologic class
                                                                    Anti-IL-12/23                                      11
that patients had been exposed previously was anti-TNF              Anti-IL23                                          0
with 44/51 (86.3%) patients having received it (Table 1). The       Number of prevoius
last biological therapy before starting tildrakizumab was dis-      ­biologic therapies
tributed as follows: 47% of patients on anti-TNF (24/51),            1 biologic agent                                  23
                                                                     ≥ 2 biologic agents                               28
31.4% on anti-IL-17 (16/51) and 21.6% on anti-IL-12/23
(11/51).                                                           BMI = body mass index; BSA = body surface area; DLQI =
    Treatment withdrawal was reported in 5.8% (3/51) of            ­Dermatology Quality of Life Impairment; PASI = Psoriasis Area Se-
                                                                    verity Index; SD = standard deviation.
patients due to lack of efficacy (1/3 patients at week 12),
loss of efficacy (1/6 patients at week 48) and lost to fol-
low up (1/6 patient at week 48). Patients withdrawing              withdrawal was observed to AEs. AEs that did not require
from the study were defined as non-responders according            tildrakizumab discontinuation were reported in 3.9% (2/51)
to the non-responder imputation method. No treatment               of patients and were represented by injection-site reactions,


Original Article | Dermatol Pract Concept. 2023;13(4):e2023215                                                                     3
                          Figure 1. Mean Psoriasis Area Severity Index (PASI), Body Surface Area (BSA), and Derma-
                          tology Life Quality Index (DLQI) score values.



     Table 2. Patients achieving residual absolute Psoriasis Area Severity Index scores of ≤ 2, ≤ 5 and
        > 5 after 12 and 48 weeks of tildrakizumab therapy. Non-responder imputation analysis.
    Week      Total patients (N)            Ongoing patients (N)           Withdrawals (N)                        PASI, N (%)
                                                                                                          ≤2            ≤5        >5
     12                51                              50                           1                   22 (43)      46 (90)    5 (10)
     48                51                              48                           2                   46 (90)       48 (94)    3 (6)

PASI = Psoriasis Area Severity Index.



    Table 3. Patients achieving PASI < 75, PASI ≥ 75, PASI ≥ 90 and PASI 100 response rates at 12 and
              48 weeks of treatment with tildrakizumab. Non-responder imputation analysis.
    Week    Total patients (N           Ongoing patients (N)        Withdrawals (N)                         PASI, N (%)
                                                                                               <75          ≥75        ≥90       100
     12              51                          50                          1                17 (33)     34 (67)     15 (30)   11 (22)
     48              51                          48                          2                5 (10)      46 (90)     35 (68)   32 (63)

PASI = Psoriasis Area Severity Index.



headache and nausea/fatigue the day after injection. A signif-          one. At week 12, the 3 groups (previous anti-TNFα,
icant reduction in the mean baseline PASI score (19.2 ± 8.5)            ­anti-IL17, anti-IL12/23) showed a dramatic improvement
was detected at 12 weeks of tildrakizumab therapy (3.5 ±                (P <0.001). No differences were found between groups also
2.7, P < 0.001), with a further improvement at week 48 (0.6             at week 48. Similarly, a difference in BSA score was also
± 1.5, P < 0.001). The PASI score reduction was associated              detected at baseline with the group on anti-IL-17 having a
with significant decrease in both baseline BSA and DLQI                 greater score than the anti-IL-12/23 group (P <0.001). At
scores (Figure 1). Absolute PASI scores of ≤ 2 and ≤ 5 were             week 12, there was a great improvement in BSA score for
achieved by 43% and 90% of patients at week 12, respec-                 all groups (P <0.001) with further increase at week 48. The
tively. A progressively higher proportion of patients achieved          effectiveness was confirmed also by DLQI assessment, with
absolute PASI scores at weeks 48. Data were analyzed ac-                a significant decrease at week 12 and even more at week 48
cording to the non-responder imputation analysis and are                (P <0.001). No differences were found among the 3 groups
shown in Table 2. Clinical amelioration was also confirmed              at all time points.
by the high percentage of patients (67%, 30% and 22%)
achieving PASI score improvement (PASI ≥ 75, PASI ≥ 90,
                                                                        Conclusions
and PASI 100) at week 12. An increase result over time up
to week 48 was observed. Detailed data analyzed according               Tildrakizumab has been shown to be well-tolerated and ef-
to the non-responder imputation analysis are summarized in              fective in treating patients with plaque psoriasis in multiple
Table 3. The evolution of clinical parameters during treat-             clinical trials, but a limited number of real-world studies
ment with tildrakizumab in patients whose last treatment                describing its safety and effectiveness have been published
was anti-TNFα, anti-IL-17 and/or anti-IL-12/23 are shown                [5-10]. Our study confirmed the elevated effectiveness of
in Figure 2. A significant difference in PASI baseline values           tildrakizumab in treating moderate-to-severe plaque pso-
was detected in the anti-IL-12/23 group respect to anti-IL17            riasis, as demonstrated by the reduction of PASI, in terms



4                                                                           Original Article | Dermatol Pract Concept. 2023;13(4):e2023215
                                                                       that we assessed tildrakizumab effectiveness in psoriasis pa-
                                                                       tients who all switched from anti-TNFα, anti-IL-17 and/or
                                                                       anti-IL-12/23.
                                                                          A much larger retrospective sub-group analysis of a
                                                                       phase 2 study and two phase 3 studies of tildrakizumab fea-
                                                                       turing 2217 patients found no association between prior ex-
                                                                       posure to biological therapies and effectiveness; there was a
                                                                       numerically greater response to tildrakizumab in bio- naïve
                                                                       patients than bio-experienced patients, but it was not sta-
                                                                       tistically significant [15]. Data from 197 patients (52.3%
                                                                       biologic non-naïve), who were treated with anti-IL-23p19
                                                                       antibodies (127 guselkumab, 55 risankizumab and 15 til-
                                                                       drakizumab) for at least 3 months, were analyzed from the
                                                                       Psoriasis Registry Austria (PsoRA). Results from this study
                                                                       indicated that biologic-non-naïve patients displayed a less
                                                                       favorable response to anti IL-23 treatment as compared to
                                                                       biologic-naïve patients. However, after correction for pre-
                                                                       vious biologic exposure, few differences in PASI improve-
                                                                       ment were detected among biologic-naïve and -non-naïve
                                                                       patients treated with different IL-23p19 inhibitors. The
                                                                       authors concluded that treatment effectiveness was not re-
Figure 2. Mean Psoriasis Area Severity Index (PASI), Body Surface      lated to the class of the previously administered therapy in
Area (BSA), and Dermatology Life Quality Index (DLQI) score val-       biologic-non-naïve patients [16]. In our study, patients who
ues in the whole population stratified by last treatment before til-
                                                                       switched from anti-IL 17 drugs to tildrakizumab had a more
drakizumab (anti-TNFα, anti-IL17, anti-IL12/23).
                                                                       severe disease. Anyhow, this difference did not affect the re-
                                                                       sponse to tildrakizumab respect to the other groups.
                                                                          In general, the rate of adverse events (3.9%) observed
of both mean PASI scores (mean baseline PASI: 19.2, mean               in this study was lower than what reported in clinical tri-
PASI score at week 48: 0.6) and percentage of patients ob-             als, but similar or lower compared to real-world patients.
taining PASI 75, 90, and 100 responses. Our findings also              [3-10,13-16] Thus, a good safety profile was observed for
showed a marked improvement in BSA and DLQI scores.                    tildrakizumab in our cohort of patients.
Our findings are in line with other real-world studies. A ret-            This study has some limitations, firstly consisting of
rospective chart review of 30 patients treated with tildraki-          the retrospective design, which does not allow collection of
zumab for moderate-to-severe plaque psoriasis from initial             missing data. Other significant limitations are the relatively
presentation to 12-month follow-up found that, similar                 small size of the sample, the lack of a randomized controlled
to our study, the mean PASI reduced from 16 to 1.5 and                 setting, and the heterogeneity of clinical assessment among
that no serious adverse events were reported [13]. Another             clinicians from different centers.
real-world data study involving 59 psoriatic patients also re-            This study confirms the effectiveness of tildrakizumab
ported a favorable response to tildrakizumab, with a PASI ≤            in daily clinical practice in patients with moderate-to-severe
3 being achieved at 28 weeks in 80% of patients. In addition,          plaque psoriasis. Moreover, our observation period up
the authors reported no statistically significant association          to week 48 confirms that the efficacy of tildrakizumab
between prior exposure to biological therapies and effec-              was maintained over time. All the enrolled patients were
tiveness, since PASI90 at 28 weeks was achieved by 68%                 biologic-exposed, and the treatment effectiveness was not
of bio-naïve patients and by 60% of bio-experienced pa-                related to the class of the previously administered therapy.
tients [8]. An Italian retrospective study included 237 adults         Therefore, this IL-23p19 inhibitor represents a promising
with moderate-to-severe plaque psoriasis, enrolled in 10               treatment alternative for patients who have not responded
different centers and treated with tildrakizumab up to week            to previous biologics.
52. At week 52, 90.91%, 73.55% and 58.68% of patients
achieved a PASI 75, PASI 90 and PASI 100, respectively. An
absolute PASI ≤ 2 was reached by 85.95% at Week 52 [14].               Informed Consent: Informed consent was taken from all the
We observed similar rates of PASI 75/90/100 responses in               patients for the application of treatment and for the use of
the present study. Notably, it has to be taken into account            data and photographs.



Original Article | Dermatol Pract Concept. 2023;13(4):e2023215                                                                     5
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