Clinical Improvement With Tildrakizumab in Refractory Psoriatic Nail Disease and Psoriatic Arthritis

Fingernail psoriasis
Left hand thumb with fingernail psoriasis. Psoriasis is an autoimmune disease.
Researchers reported on the clinical response of a patient with psoriatic nail dystrophy and psoriatic arthritis who received treatment with tildrakizumab.

Humanized monoclonal antibody tildrakizumab may show clinical improvement for both refractory psoriatic nail disease and psoriatic arthritis (PsA), according to study results published in Dermatologic Therapy.

Researchers of this report addressed the excellent clinical response of a 40-year-old man with psoriatic nail dystrophy and PsA who received treatment with tildrakizumab. After diagnosis with PsA, the patient received treatment with 20 mg methotrexate weekly and 10 mg folic acid weekly. After 4 months, methotrexate was replaced by 1 g sulfasalazine twice daily due to ongoing synovitis in the patient. With a psoriatic nail disease diagnosis, the patient was prescribed clobetasol dipropionate 0.05% ointment and monthly injections of triamcinolone acetonide for the affected nails. Minimal clinical improvement was seen in the patient, and 20 mg weekly methotrexate was restarted for his active PsA.

The patient did not meet the biologic therapy eligibility criteria for PsA, according to the Australian Pharmaceutical Benefits Scheme, because of the low C-reactive protein with methotrexate and sulfasalazine.

With approval from the Australian Therapeutic Goods Administration, tildrakizumab was administered subcutaneously at weeks 0 and 4. After 12 weeks, when the patient presented for his third dose of 100 mg tildrakizumab, there were significant improvements in both nail dystrophy and arthritis, with an overall reduction in pain to the affected joints; no adverse effects were reported by the patient.

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“The clinical response observed in this patient suggests that tildrakizumab may be an effective treatment option for both refractory psoriatic nail disease and [PsA],” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Ismail FF, May J, Moi J, Sinclair R. Clinical improvement in psoriatic nail disease and psoriatic arthritis with tildrakizumab treatment [published online January 3, 2020]. Dermatol Ther. doi:10.1111/dth.13216