Switching to an interleukin-17 inhibitor (IL-17i) after failure of a first tumour necrosis factor inhibitor (TNFi) is associated with significantly better treatment retention than cycling to a second TNFi, according to a large real-world multicentre study in patients with psoriatic arthritis (PsA).
The retrospective analysis, conducted across 25 centres and published in BMC Rheumatology, evaluated treatment persistence as a proxy for effectiveness in patients requiring second-line biologic therapy following TNFi failure.
Higher Retention Rates With IL-17 Inhibitor Switching
A total of 452 patients with PsA were included, of whom 275 received a second TNFi (cycling group) and 177 switched to an IL-17 inhibitor (swap group). Kaplan–Meier survival analyses demonstrated significantly higher treatment retention in the swap group compared with the cycling group (p<0.001).
Retention rate is commonly used in real-world studies as an indicator of both effectiveness and tolerability, capturing treatment discontinuation due to inefficacy, adverse events, or other clinical factors.
Cycling Strategy Linked to Higher Risk of Treatment Discontinuation
Cox regression analysis identified several independent predictors of treatment interruption. The cycling strategy itself was strongly associated with higher discontinuation risk (p<0.001). Additional factors linked to poorer retention included higher Disease Activity in Psoriatic Arthritis scores, axial disease involvement, mixed peripheral and axial disease, and the year of prescription.
These findings suggest that patients with more complex or severe disease phenotypes may particularly benefit from a change in therapeutic mechanism rather than re-exposure to TNF inhibition.
Implications for Second-Line PsA Management
The authors conclude that switching to a different mechanism of action after TNFi failure may improve long-term treatment persistence in PsA. The results support a treatment strategy that prioritises biologic class switching rather than cycling within the same pathway, particularly in patients with high disease activity or axial involvement.
As therapeutic options for PsA continue to expand, real-world evidence such as this may help guide more personalised and effective sequencing of advanced therapies.
Reference
Ariani A et al. Comparative effectiveness of cycling versus swapping to UL-17 inhibitors after first TNF inhibitor failure in Psoriatic Arthritis: A real-world multicenter study. BMC Rheumatol. 2025;DOI: 10.1186/s41927-025-00587-8.
