Presentation (CTI)

OBJECTIVES: To estimate mid- to long-term treatment response up to 5 years using number needed to treat (NNT) based on PASI 75 responder rates for tildrakizumab 200mg versus selected interleukin (IL)-23 and IL-17 inhibitors in patients with moderate-to-severe plaque psoriasis.
METHODS: A model-based comparison estimated 5-year NNT for tildrakizumab 200mg and biologic comparators. Year-1 NNT was estimated using PASI 75 risk ratios from a NMA (Lebwohl et al., 2025), applied to a common placebo response rate from the pivotal tildrakizumab trial (Reich et al., 2017). Tildrakizumab 200mg efficacy was estimated using the relative effect of 200mg versus 100mg from long-term evidence stratified by obesity status. For this comparison, a mean body weight of 90 kg was assumed, corresponding to approx. 63% of patients with body mass index (BMI) >30 kg/m². Year 2-5 response rates were modelled using long-term open-label extension data for each biologic identified in a targeted literature review. Comparators were guselkumab 100mg, risankizumab 150mg, secukinumab 300mg, ixekizumab 80mg, brodalumab 210mg, and bimekizumab 320mg.
RESULTS: Estimated NNT values spanned from 2.1 for tildrakizumab 200mg to 2.3 for brodalumab at year 1, and from 2.2 to 2.5 at year 2. At year 5, NNT values spanned from 2.3 to 3.9 across both compounds. Rankings were broadly similar and consistent across all time points and compounds.
CONCLUSIONS: In this model-based NMA comparison, NNT rankings based on estimated PASI 75 response rates for patients with high body weight remained stable across included biologics in the long term up to 5 years. Tildrakizumab 200mg showed one of the lowest NNTs at all time points, with year-1 and year-2 favorable trends maintained through year 5. These findings should be interpreted with caution, considering the indirect comparison modelling, common placebo anchoring, and treatment-specific long-term extrapolation.