Does Prior Exposure Affect Retention? A Real-World, Multicentre Assessment of IL-17 Inhibitor Cycling in Psoriatic Arthritis
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Interleukin-17 inhibitors (IL-17i) represent a key therapeutic option for psoriatic arthritis (PsA), but real-world evidence regarding the effectiveness of cycling strategies within this class is lacking. This study evaluated the real-world retention of IL-17i in PsA, focusing on whether prior IL-17i exposure affects subsequent IL-17i persistence. METHODS: This multicentre, retrospective, observational study included consecutive patients with PsA treated with an IL-17i across 24 Italian rheumatology centres. The primary outcome was drug retention, analysed using Kaplan-Meier methods, with differences between IL-17i-naïve and IL-17i-experienced patients assessed with the log-rank test. Secondary outcomes included baseline clinical characteristics and predictors of discontinuation. RESULTS: A total of 868 patients were included (59.3% female, 40.7% male; median age 56 [48-63] years; 89.3% IL-17i-naïve). The overall median IL-17i retention rate was 90.7% [95% CI 88.7-92.8] at 6 months, 77.5% [95% CI 74.6-80.6] at 12 months, 60.9% [95% CI 57.3-64.8] at 24 months, and 52.1% [95% CI 48.1-56.4] at 36 months. Among IL-17i-naïve patients, retention rates were 90.5%, 77.6%, 61.7%, and 53.9% at 6, 12, 24, and 36 months, respectively. Among IL-17i-experienced patients, the corresponding retention rates were 92.2%, 77.0%, 54.0%, and 33.9%. In multivariable Cox regression, male sex and prior IL-17 inhibitor exposure were associated with a lower risk of discontinuation, whereas axial involvement, a higher number of previous biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs), and later calendar year of IL-17i initiation predicted poorer retention. CONCLUSIONS: IL-17i showed high long-term retention in real-world PsA, with no significant difference between naïve and previously exposed patients. These findings support the sustained effectiveness of IL-17i therapy and suggest that cycling within the class may remain a reasonable option for selected cases.
Source: Rheumatology and Therapy
Authors: Valentino Paci, Alarico Ariani, Eleonora Celletti, Olga Addimanda, Alberto Lo Gullo, Camilla Mazzanti, Myriam Di Penta, Emanuela Sabatini, Francesco Cipollone, Gianluca Santoboni, Claudio Angrisani, Massimiliano De Simone, Valeria Nucera, Aurora Ianniello, Giulia Vallifuoco, Natalia Mansueto, Romina Andracco, Giulio Ferrero, Rosalba Caccavale, Marino Paroli, Patrizia Del Medico, Gianluca Smerilli, Antonella Farina, Palma Scolieri, Vincenzo Bruzzese, Cecilia Giampietro, Francesca Ometto, Gentiana Vukatana, Marica Trevisani, Rita Mulè, Elisa Rossi, Enrica Vandelli, Riccardo Bixio, Alessandro Volpe, Antonio Marchetta, Maddalena Larosa, Dario Camellino, Gerolamo Bianchi, Viviana Ravagnani, Federica Lumetti, Aldo Biagio Molica Colella, Veronica Franchina, Francesco Molica Colella, Elena Bravi, Ilaria Platè, Eugenio Arrigoni, Rosetta Vitetta, Francesca Serale, Alessia Fiorenza, Davide Murgia, Guido Rovera, Gabriele Amati, Elisa Visalli, Giorgio Amato, Francesco De Lucia, Ylenia Dal Bosco, Roberta Foti, Enrico Fusaro, Maria Chiara Ditto, Simone Bernardi, Francesco Girelli, Marta Priora, Alessandra Bezzi, Maria Cristina Focherini, Fabio Mascella, Andrea Becciolini, Eleonora Di Donato, Giuditta Adorni, Gianluca Lucchini, Daniele Santilli, Beatrice Gabrielli, Dilia Giuggioli, Bernd Raffeiner, Massimo Reta, Mirco Magnani, Luca Idolazzi, Gilda Sandri, Rosario Foti, Simone Parisi, Michele Maria Luchetti Gentiloni, Gianluca Moroncini
Institutions: Marche Polytechnic University, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Chieti-Pescara, Ospedale SS. Annunziata, Azienda Sanitaria Locale Viterbo, Sapienza University of Rome, L'organizzazione Ospedale di Civitanova M, Ospedale Sacro Cuore Don Calabria, Ospedale Santa Chiara, Azienda Ospedaliero-Universitaria di Modena, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, Guglielmo da Saliceto Hospital, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Ospedale G.B. Morgagni - L.Pierantoni, University of Parma, Ospedale di Parma, Ospedale di Bolzano, Azienda Sanitaria dell'Alto Adige, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $7,400
OpenAlex ID: W7135387151