Tildrakizumab Shows Significant Efficacy in Psoriasis Treatment With Comorbid Immunoglobulin A Nephropathy: A Case Report

Background: Chronic kidney disease is a relative contraindication for conventional systemic therapy in patients with psoriasis. Although biologic agents may be suitable in these patients due to their elimination via endogenous metabolism and protein degradation, no dedicated studies have evaluated the safety of biologics in patients with psoriasis and chronic kidney disease. Tildrakizumab—an anti-interleukin-23p19 monoclonal antibody—is approved for treatment of moderate-to-severe plaque psoriasis. Objective: To evaluate efficacy and safety of tildrakizumab in a 56-year-old woman with moderate-to-severe plaque psoriasis and comorbid immunoglobulin A nephropathy. Methods: Subcutaneous tildrakizumab 100 mg was administered at weeks 0, 4, 20, 33, and 48. Assessments included body surface area affected, physician’s global assessment score, and laboratory assessments. Results: At initial presentation, patient had predominantly plaque-type psoriasis involving 5% body surface area with a static physician’s global assessment score of 3. Patient failed an adequate trial of ultrapotent topical steroids. Baseline laboratory tests confirmed renal impairment with blood creatinine level of 2.0 mg/dL and an estimated glomerular filtration rate of 27.0 mL/min/1.73 m2. Administration of subcutaneous tildrakizumab 100 mg led to near-complete skin clearance by week 33, with a durable response to week 48. No treatment-related adverse events were reported through 48 weeks. Metabolic and hematological parameters remained grossly unchanged. Conclusion: Tildrakizumab was well tolerated and effective for treatment of moderate-to-severe plaque psoriasis in a patient with comorbid immunoglobulin A nephropathy.