Effectiveness and Safety After a Switch to Tildrakizumab: A Real World Multicenter Italian Study in Psoriasis

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 (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 patients with moderate-to-severe plaque psoriasis.

Characterization of Adnexal Masses by Transvaginal Sonography and Color Flow Doppler

We assessed the accuracy of transvaginal sonography and color flow Doppler to distinguish benign from malignant adnexal masses and to select patients for laparoscopy. Before surgery, 225 women with adnexal masses were examined by transvaginal sonography and color flow Doppler. Size and morphologic criteria of each mass were determined, and color flow Doppler characteristics were evaluated. Of the 225 patients, 166 were premenopausal (mean age 34.6 &plusmn; 9.2 yrs) and 59 had been postmenopausal for at least 1 year (mean age 61.9 &plusmn; 7.5 yrs). Operative laparoscopy was performed in 22% of postmenopausal and 50% of premenopausal women, for a total of 96 laparoscopies. We observed 32 malignant tumors, 16 in premenopausal (10%) and 17 in postmenopausal women (29%). Analysis of gray scale morphologic findings revealed solid tissue in 77.8% of malignant and 16.1% of benign tumors (p <0.05). The presence of septa within the cysts was not significantly different in malignant and benign tumors. No sonographically simple adnexal cyst was malignant. Color flow Doppler alone seems to be less predictive of malignancy, but if combined with gray scale, is able to improve the diagnosis.

[An increase in the median plasma values of progesterone in luteal deficiencies treated with clomifene citrate in the early follicular phase]

A clinical study performed during 265 cycles in 63 normo-ovulating and normo-menstruating patients, of whom 27 with a luteal phase defect (LPD), assessed by morphological, hormonal, echographic and clinic criteria. These were given Clomiphene Citrate, 100 mg per day from the second to sixth day of the cycle, for a total of 108 cycles. The other 36 patients, without any luteal abnormality, were utilized as a control group during 156 cycles. At the end of the study there were no significant differences in hormonal, echographic and morphological parameters between the two groups.

Efficacy of biochemical vs biological monitoring during the "timing" of the chorionic gonadotropin administration in FSH and HMG stimulated cycles

The problem of an exact timing of the HCG administration in stimulated cycles (for infertility problems) is of primary importance for optimizing the results. In this study the authors show the results obtained in two groups of patients to whom HCG was administered according to two different methods of monitoring: the first biochemical, the second biological. The examination of the results has proven that the insertion of the biological method (cervical mucus) among those used in the monitoring has allowed a significant increase of the biological response to treatment.