How does Ilumya compare to other treatments?

Q: How does Ilumya compare to other treatments?

There have been few comparative trials comparing Ilumya to other biologics used for the treatment of moderate to severe plaque-type psoriasis. The joint AAD and NPF guidelines conclude that all 11 biologics have grade A evidence for efficacy as monotherapy in plaque psoriasis and a person’s medical and social should be taken into account when choosing a biologic. Certain biologics may be preferred in people who are overweight because they use weight-based dosing (such as infliximab or Stelara), whereas others may be preferred in those with poor compliance because they are dosed every 12 weeks (such as Stelara, Skyrizi or Ilumya).

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 6, 2024.

Official Answer by Drugs.com

Ilumya (tildrakizumab) is a biologic that was FDA approved for the treatment of moderate-to-severe plaque psoriasis in adults in 2018. There are now at least eleven biologics that have been approved to treat psoriasis; however, few trials compare one to another. All are more effective than placebo (a treatment that has no active ingredient). Other biologics approved to treat plaque psoriasis include:

adalimumab (Humira)
brodalumab (Siliq)
certolizumab pegol (Cimzia)
etanercept (Enbrel)
infliximab (Remicade)
guselkumab (Tremfya)
ixekizumab (Taltz)
ustekinumab (Stelara)
secukinumab (Cosentyx)
risankizumab (Skyrizi).

These agents differ in the way that they work (some inhibit tumor necrosis factor [TNF], others block cytokines, such as interleukin 12 (IL-12), IL-23 or IL-17). They also differ in how frequently they need to be administered and there is some difference in cost.

According to guidelines issued by the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) in 2019 regarding the choice of biologics for plaque psoriasis:

Biologics have a high benefit to risk profile and are an effective treatment choice for people with moderate-to-severe plaque psoriasis
Of the 11 biologics currently available, there is no optimal or preferred biologic
All 11 biologics have been ranked by the AAD and NPF as having grade A evidence for efficacy as monotherapy in the treatment of moderate to severe plaque-type psoriasis. Some biologics may be preferred over others for certain types of psoriatic disease (such as scalp psoriasis, nail psoriasis, and palmoplantar disease)
Choice of biologic should be made taking into account a person’s medical and social factors
In people who are overweight or obese, infliximab utilizes proportional-to-weight dosing and may be preferred in patients with higher body mass; Stelara also considers patient weight.
IL-17 inhibitor treatment may reactivate or worsen IBD. TNF-α inhibitors and Stelara are approved treatments for patients with IBD and may be recommended in patients with comorbid psoriasis
Avoid TNF-α inhibitors in people with class III and class IV congestive heart failure or multiple sclerosis
Brodalumab has been associated with suicide, avoid in people with a history of suicidal ideation or recent suicidal behavior
Stelara, Ilumya, and Skyrizi only require dosing every 12 weeks after administration of loading doses and maybe the best options for optimizing compliance
Once a biologic has been decided upon, physicians should monitor how effective that biologic is and for the presence of side effects. A lack of response, loss of response, or severe side effects may warrant switching to a different biologic or the addition of other treatments.
Biologics may be given as monotherapy or in addition to other therapies
People who are prescribed biologics are at a higher risk for infection and important considerations need to made when immunizing and planning for surgery.

How does Ilumya compare with other IL-23 inhibitors?

The IL-23 monoclonal antibodies are the most recent generation of psoriasis biologics.

Ilumya was the second IL-23 inhibitor approved behind Johnson and Johnson’s Tremfya (guselkumab) which was approved in 2017. There is also a combined IL-12/23 inhibitor called Stelara (ustekinumab) that was first approved for plaque psoriasis in adults in 2009, and the approval then expanded to include adolescents (2017) and then children (2020). The most recent IL-23 inhibitor to be approved is Skyrizi (risankizumab), in 2019. Important differences to note include:

After an initial loading dose, Tremfya is administered every 8 weeks, Ilumya, Stelara, and Skyrizi are administered every 12 weeks
All are effective
Skyrizi has a faster onset of action
A comparative trial that compared Skyrizi to Stelara found Skyrizi to be more effective. At week 16, PASI 90 was achieved by 75% of Skyrizxi patients but only 42% of Stelara patients. By week 52, PASI90 was achieved by 82% of Skyrizi patients and only 44% of Stelara patients.
Skyrizi also had a faster onset of action to Stelara, with 44% achieving PASI 90 by week four compared with only 19% with Stelara. Fewer adverse events were seen with Skyrizi compared with Stelara: however, the risk of serious infections was similar (but low). In people with a BMI >30, there was a slight loss of response with Skyrizi.
Overall, Ilumya has a similar number of AEs when compared to Stelara and Tremfya.

References

Pithadia DJ, Reynolds KA, Lee EB, et al. Translating the 2019 AAD-NPF Guidelines of Care for the Management of Psoriasis With Biologics to Clinical Practice MD Edge: Dermatology https://www.mdedge.com/dermatology/article/206353/mixed-topics/translating-2019-aad-npf-guidelines-care-management
Menter A, Strober B, Kaplan D et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019;80:1029-72. https://www.jaad.org/action/showPdf?pii=S0190-9622%2818%2933001-9
Ilumya (tildrakizumab-asmn) 07/2020 Sun Pharmaceutical Industries, Inc. https://www.drugs.com/pro/ilumya-injection.html

How long does it take Ilumya to work?

It takes approximately 12 weeks for Ilumya to start working with nearly 60% of people experiencing a 75% reduction in the severity of their psoriasis within that time; however, it may take over a year for the full benefits to be seen. Continue reading

How does Ilumya affect my immune system?

Ilumya affects the immune system by blocking the effects of IL-23, a proinflammatory cytokine that helps to regulate inflammation associated with autoimmune conditions, such as psoriasis) as well as bacterial and viral infections. By blocking the effects of IL-23, Ilumya increases your risk of developing infections and may cause the reactivation of latent tuberculosis; however, the risk of serious infections is low (0.3%) and the same as placebo. Continue reading

What are the side effects of Ilumya?

Upper respiratory infections, injection site reactions, and diarrhea are the most commonly reported side effects of Ilumya. Continue reading

How does Ilumya compare to other treatments?

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