Tildrakizumab Delivers Sustained Skin Clearance and High-Impact Area Control Over 2 Years in Real-World Psoriasis Study

Two-year real-world data from the POSITIVE study demonstrate that tildrakizumab provides sustained skin clearance and meaningful improvements in high-impact psoriasis areas, reinforcing its long-term effectiveness in routine clinical practice.

“Psoriasis is a chronic inflammatory disease that commonly involves high-impact areas, such as scalp, palms or soles, or nails. The burden of disease, particularly when these areas are affected, is very high,” the investigators noted. This study evaluated long-term outcomes with tildrakizumab in both overall disease and difficult-to-treat anatomical sites. 

The POSITIVE study is a 2-year, non-interventional study including 785 patients with moderate-to-severe plaque psoriasis treated with tildrakizumab. Effectiveness endpoints included Psoriasis Area and Severity Index (PASI) and Physician Global Assessment (PGA) scores for scalp, palmoplantar, and nail involvement. 

Tildrakizumab demonstrated rapid and sustained improvements in overall disease severity. The mean PASI scores decreased from 12.9 at baseline to 2.4 at week 16 and further to 1.3 at year 2 (P<0.0001), reflecting near-complete skin clearance. 

High levels of response were maintained over time. By week 16, 73.3% of patients achieved PASI ≤3, increasing to 87.9% at year 2. Similarly, PASI ≤1 responses improved from 41.3% at week 16 to 65.1% at year 2, indicating continued gains beyond initial treatment. 

Importantly, improvements extended to high-impact areas. At year 2, 89.3% of patients achieved scalp-PGA 0/1, 96.9% palmoplantar-PGA 0/1, and 90.3% nail-PGA 0/1, demonstrating robust control in anatomically challenging regions. 

Treatment persistence was also high, with drug survival rates of 96.3% due to adverse events and 87.8% due to lack of effectiveness over 2 years. 

“In a real-world setting, tildrakizumab significantly improved skin clearance in patients with moderate-to-severe plaque psoriasis after 16 weeks, with further improvement observed over the 2-year period,” the authors concluded. “Tildrakizumab showed marked and sustained improvement in high-impact areas such as the scalp, palms or soles, and nails throughout 2 years.” 

These findings highlight the durability of tildrakizumab across both overall disease and high-burden anatomical sites, supporting its role as a long-term treatment option in psoriasis.

Reference

Augustin M, Sommer R, Gerdes S, et al. Sustained effectiveness of tildrakizumab in patients with moderate-to-severe psoriasis overall and in high-impact areas: 2-year results from the POSITIVE study. Presented at: American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, Colorado.