Comparative effectiveness of cycling versus swapping to IL-17 inhibitors after first TNF inhibitor failure in Psoriatic Arthritis: A real-world multicenter study
Year: 2025
Type: article
Study design: Observational Study
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. CLINICAL TRIAL NUMBER: Not applicable.
Source: BMC Rheumatology
Authors: Alarico Ariani, Maddalena Larosa, Alberto Lo Gullo, Olga Addimanda, Romina Andracco, Patrizia Del Medico, Marino Paroli, Maria Chiara Ditto, Bernd Raffeiner, Aurora Ianniello, Francesca Ometto, Marta Priora, Aldo Biagio Molica Colella, Elena Bravi, Viviana Ravagnani, Alessandra Bezzi, Rosetta Vitetta, Palma Scolieri, Alessandro Volpe, Federica Lumetti, Antonella Farina, Francesco Girelli, Elisa Visalli, Francesca Serale, Eleonora Celletti, Veronica Franchina, Francesco Molica Colella, Giulio Ferrero, Fabio Mascella, Maria Cristina Focherini, Alessia Fiorenza, Guido Rovera, Cecilia Giampietro, Simone Bernardi, Natalia Mansueto, Dario Camellino, Rosalba Caccavale, Valeria Nucera, Myriam Di Penta, Emanuela Sabatini, Ilaria Platè, Adorni Giuditta, Eleonora Di Donato, Daniele Santilli, Gianluca Lucchini, Mirco Magnani, Gianluca Smerilli, Giorgio Amato, Francesco De Lucia, Ylenia Dal Bosco, Roberta Foti, Francesco Cipollone, Gerolamo Bianchi, Rosario Foti, Eugenio Arrigoni, Antonio Marchetta, Vincenzo Bruzzese, Gilda Sandri, Enrico Fusaro, Massimo Reta, Dilia Giuggioli, Antonio Marchesoni, Simone Parisi, Andrea Becciolini
Institutions: University of Parma, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, Ospedale di Parma, L'organizzazione Ospedale di Civitanova M, Sapienza University of Rome, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Ospedale di Bolzano, Azienda Sanitaria dell'Alto Adige, Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, Guglielmo da Saliceto Hospital, Ospedale Santa Chiara, Ospedale Sacro Cuore Don Calabria, Azienda Ospedaliero-Universitaria di Modena, Ospedale G.B. Morgagni - L.Pierantoni, University of Chieti-Pescara, Ospedale SS. Annunziata, University of Milano-Bicocca, Ospedale Santa Corona, University of Modena and Reggio Emilia
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,190
OpenAlex ID: W4416607736