In "Real-World Persistence Data for IL-23 Biologics in Plaque Psoriasis," the panel examines what claims-database research reveals about how patients actually stay on their biologic over time.

The case advances: given the patient's dexterity and adherence challenges, her dermatologist initiates tildrakizumab, an IL-23-targeted biologic administered in-office by a healthcare professional every 12 weeks. Dr. Bunick asks Dr. Armstrong how she evaluates real-world treatment patterns among IL-23 biologics for moderate-to-severe plaque psoriasis, naming tildrakizumab, risankizumab, guselkumab, and ustekinumab specifically. Armstrong describes claims-database research she has conducted that tracks how consistently patients refill their prescriptions over time as a proxy for real-world persistence.

Across the IL-23 class broadly, Armstrong reports strong persistence, which she attributes to both solid efficacy and infrequent dosing intervals. For tildrakizumab specifically, she notes particularly good adherence, which she credits in part to its in-office administration model removing the burden of self-injection from the patient entirely. She frames patient selection, insurance structure, and dosing interval as interacting factors that all influence these real-world outcomes. Tildrakizumab, she says, stands out for elderly patients carrying multiple comorbidities who need a therapy that is both reliably safe and reliably administered.

Dr. Bunick agrees, emphasizing that for a 72-year-old Medicare patient managing polypharmacy, tildrakizumab's safety profile is a genuine advantage. He points to the broader IL-23 class's long-term durability data as a significant asset for psoriasis patients generally, not just this case. The exchange underscores a recurring theme across the program: that persistence and adherence data, not efficacy claims alone, should inform which biologic best fits a specific patient's life circumstances, particularly when comorbidities, cost, and administration setting all compound the decision. With this case resolved, the panel transitions to their third and final patient case.

Our next episode, "Case 3: Managing Plaque Psoriasis in a Shift-Working Hospital Administrator," introduces a 34-year-old shift worker whose rotating schedule and limited response to a prior biologic complicate her treatment plan.