Objective The increase in biological disease-modifying antirheumatic drugs for psoriatic arthritis (PsA) made it possible to consider different mechanisms of action (MoA) after the failure of the first advanced-line therapy. However, there is still a lack of real-world evidence comparing the cycling (re-administration of a similar MoA) and the swap strategy. This retrospective observational study aims to evaluate the retention rate, as a proxy for effectiveness, of second-line therapeutic options after the failure of a TNF inhibitor (TNFi) by comparing cycling versus swap strategies. Methods PsA patients who failed the first-line TNFi and subsequently received either a TNFi or IL-17i were retrospectively selected from 25 centers. We collected demographic and disease-related data (disease duration, clinical phenotype, Disease Activity in Psoriatic Arthritis score), concomitant use of conventional synthetic disease- modifying antirheumatic drugs. Patients were categorized into cycling (second TNFi) (CG) or swapping (switch to IL-17i) (SG) groups. Kaplan-Meier survival curves were used to evaluate the retention rate, and a Cox regression analysis was performed to identify risk factors influencing treatment retention. Results In CG and SG there were 275 and 177 patients, respectively. Retention rate in SG was higher than in CG (p < 0.001). Treatment interruption predictors were cycling strategy (p < 0.001), Disease Activity in Psoriatic Arthritis (p = 0.013), prescription year (p = 0.016), axial (p = 0.013), mixed involvement (p = 0.001). Conclusion The swap strategy showed higher treatment retention than cycling in PsA patients who failed the first- line TNFi. This finding supports the hypothesis that changing MoA may improve the chances of selecting the most effective PsA treatment.
Comparative effectiveness of cycling versus swapping to IL-17 inhibitors after first TNF inhibitor failure in Psoriatic Arthritis: A real- world multicenter study / Ariani, Alarico; Larosa, Maddalena; Lo Gullo, Alberto; Addimanda, Olga; Andracco, Romina; Del Medico, Patrizia; Paroli, Marino; Chiara Ditto, Maria; Raffeiner, Bernd; Ianniello, Aurora; Ometto, Francesca; Priora, Marta; Biagio Molica Colella, Aldo; Bravi, Elena; Ravagnani, Viviana; Bezzi, Alessandra; Vitetta, Rosetta; Scolieri, Palma; Volpe, Alessandro; Lumetti, Federica; Farina, Antonella; Girelli, Francesco; Visalli, Elisa; Serale, Francesca; Celletti, Eleonora; Franchina, Veronica; Molica Colella, Francesco; Ferrero, Giulio; Mascella, Fabio; Cristina Focherini, Maria; Fiorenza, Alessia; Rovera, Guido; Giampietro, Cecilia; Bernardi, Simone; Mansueto, Natalia; Camellino, Dario; Caccavale, Rosalba; Nucera, Valeria; Di Penta, Myriam; Sabatini, Emanuela; Platè, Ilaria; Giuditta, Adorni; Di Donato, Eleonora; Santilli, Daniele; Lucchini, Gianluca; Magnani, Mirco; Smerilli, Gianluca; Amato, Giorgio; De Lucia, Francesco; Dal Bosco, Ylenia; Foti, Roberta; Cipollone, Francesco; Bianchi, Gerolamo; Foti, Rosario; Arrigoni, Eugenio; Marchetta, Antonio; Bruzzese, Vincenzo; Sandri, Gilda; Fusaro, Enrico; Reta, Massimo; Giuggioli, Dilia; Marchesoni, Antonio; Parisi, Simone; Becciolini, Andrea. - In: BMC RHEUMATOLOGY. - ISSN 2520-1026. - (2025).
Comparative effectiveness of cycling versus swapping to IL-17 inhibitors after first TNF inhibitor failure in Psoriatic Arthritis: A real- world multicenter study
Marino Paroli;Rosalba Caccavale;
2025
Abstract
Objective The increase in biological disease-modifying antirheumatic drugs for psoriatic arthritis (PsA) made it possible to consider different mechanisms of action (MoA) after the failure of the first advanced-line therapy. However, there is still a lack of real-world evidence comparing the cycling (re-administration of a similar MoA) and the swap strategy. This retrospective observational study aims to evaluate the retention rate, as a proxy for effectiveness, of second-line therapeutic options after the failure of a TNF inhibitor (TNFi) by comparing cycling versus swap strategies. Methods PsA patients who failed the first-line TNFi and subsequently received either a TNFi or IL-17i were retrospectively selected from 25 centers. We collected demographic and disease-related data (disease duration, clinical phenotype, Disease Activity in Psoriatic Arthritis score), concomitant use of conventional synthetic disease- modifying antirheumatic drugs. Patients were categorized into cycling (second TNFi) (CG) or swapping (switch to IL-17i) (SG) groups. Kaplan-Meier survival curves were used to evaluate the retention rate, and a Cox regression analysis was performed to identify risk factors influencing treatment retention. Results In CG and SG there were 275 and 177 patients, respectively. Retention rate in SG was higher than in CG (p < 0.001). Treatment interruption predictors were cycling strategy (p < 0.001), Disease Activity in Psoriatic Arthritis (p = 0.013), prescription year (p = 0.016), axial (p = 0.013), mixed involvement (p = 0.001). Conclusion The swap strategy showed higher treatment retention than cycling in PsA patients who failed the first- line TNFi. This finding supports the hypothesis that changing MoA may improve the chances of selecting the most effective PsA treatment.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
