More biologic disease-modifying antirheumatic drugs (bDMARDs) are available now, with distinct mechanisms of action that have broadened treatment options for psoriatic arthritis (PsA). In routine clinical practice, treatment decisions following bDMARD failure often involve choosing between cycling within the same drug class, commonly tumor necrosis factor inhibitors (TNFi), or swapping to an alternative class, such as interleukin-17 inhibitors (IL17i). This monocentric retrospective observational study aimed to compare the effectiveness of cycling (TNFi to another TNFi) versus swapping strategies (TNFi to IL17i or IL17i to TNFi) by evaluating drug retention rates and finding factors associated with treatment persistence. A total of 122 PsA patients treated with TNFi or IL17i between 2016 and 2022 were included and grouped into one cycling group (CG) and two swap groups: TNFi to IL17i (SG1) and IL17i to TNFi (SG2). Notably, the SG1 strategy was associated with better retention compared to CG (HR, 0.53; 95% CI, 0.31–0.89; P = .02). Other factors influencing retention included younger age (HR, 0.98; 95% CI, 0.96–0.99; P = .003), higher PsA disease activity (HR, 1.11; 95% CI, 1.08–1.13; P < .0001), and later year of switch (HR, 1.78; 95% CI, 1.39–2.22; P < .0001).

These real-world findings suggest that in patients who have PsA, swapping from TNFi to IL17i may result in greater treatment persistence than cycling within the TNFi class.

Reference: Lumetti F, Ariani A, Marchesoni A, et al. Cycling versus swapping strategies with TNF-α inhibitors and IL-17 inhibitors in psoriatic arthritis in clinical practice. Sci Rep 14, 24922 (2024). https://doi.org/10.1038/s41598-024-75190-x