Comparative effectiveness of cycling versus swapping to UL-17 inhibitors after first TNF inhibitor failure in Psoriatic Arthritis: A real- world multicenter study

he increase in biological disease-modifying antirheumatic drugs for psoriatic
153 arthritis (PsA) made it possible to consider different mechanisms of action (MoA)
154 after the failure of the first advanced-line therapy. However, there is still a lack
155 of real-world evidence comparing the cycling (re-administration of a similar MoA)
156 and the swap strategy. This retrospective observational study aims to evaluate
157 the retention rate, as a proxy for effectiveness, of second-line therapeutic
158 options after the failure of a TNF inhibitor (TNFi) by comparing cycling versus
159 swap strategies.
160 Methods
161 PsA patients who failed the first-line TNFi and subsequently received either a
162 TNFi or IL-17i were retrospectively selected from 25 centers. We collected
163 demographic and disease-related data (disease duration, clinical phenotype,
164 Disease Activity in Psoriatic Arthritis score), concomitant use of conventional
165 synthetic disease-modifying antirheumatic drugs. Patients were categorized into
166 cycling (second TNFi) (CG) or swapping (switch to IL-17i) (SG) groups. Kaplan-
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167 Meier survival curves were used to evaluate the retention rate, and a Cox
168 regression analysis was performed to identify risk factors influencing treatment
169 retention.
170 Results
171 In CG and SG there were 275 and 177 patients, respectively. Retention rate in
172 SG was higher than in CG (p<0.001). Treatment interruption predictors were
173 cycling strategy (p<0.001), Disease Activity in Psoriatic Arthritis (p=0.013),
174 prescription year (p=0.016), axial (p=0.013), mixed involvement (p=0.001).
175 Conclusion
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176 The swap strategy showed higher treatment retention than cycling in PsA
177 patients who failed the first-line TNFi. This finding supports the hypothesis that
178 changing MoA may improve the chances of selecting the most effective PsA
179 treatment.
180 Clinical trial number: not applicable
181
182 Keywords
183 Psoriatic arthritis, TNFi, IL-17i, drug retention rate, bDMARDs, switch, cycling
184 strategy, swap strategy.