Efficacy Comparison of Cycling Versus Transitioning to IL-17 Inhibitors Following Initial TNF Inhibitor Failure in Psoriatic Arthritis: A Multicenter Real-World Analysis - Report - MDSpire

Efficacy Comparison of Cycling Versus Transitioning to IL-17 Inhibitors Following Initial TNF Inhibitor Failure in Psoriatic Arthritis: A Multicenter Real-World Analysis

  • By

  • 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

  • November 24, 2025

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Efficacy of Cycling TNFi Versus Switching to IL-17i After TNFi Failure in Psoriatic Arthritis

Overview

This multicenter retrospective study compared treatment retention rates between cycling TNF inhibitors (TNFi) and switching to interleukin-17 inhibitors (IL-17i) after initial TNFi failure in psoriatic arthritis (PsA). Among 452 patients, retention rates and baseline characteristics were analyzed to identify factors influencing treatment persistence.

Background

Psoriatic arthritis treatment has expanded with multiple biological DMARDs (bDMARDs) offering different mechanisms of action (MoA). TNF inhibitors remain first-line after csDMARD failure, but the optimal second-line strategy after TNFi failure—either cycling another TNFi or swapping to IL-17i—is unclear. Real-world data on retention rates can guide clinical decisions, as treatment persistence is a proxy for effectiveness. This study addresses the gap by comparing these strategies in a large Italian cohort.

Data Highlights

CharacteristicCycling Group (TNFi to TNFi)Swap Group (TNFi to IL-17i)
Number of patients275 (60.8%)177 (39.2%)
Median observation period13 months (IQR 6–31)
HLA-B27 assessment frequencyLowerHigher (p < 0.01)
Baseline disease activity (DAPSA)Majority moderate activityMajority moderate activity

Key Findings

  • 452 PsA patients met inclusion criteria, with 60.8% cycling TNFi and 39.2% switching to IL-17i after first TNFi failure.
  • Median follow-up was 13 months, totaling 9,905 patient-months of observation.
  • Baseline characteristics were similar between groups except more frequent HLA-B27 testing in the swap group (p < 0.01).
  • Most patients in both groups exhibited moderate disease activity at baseline per DAPSA scores.
  • Retention rate was the primary outcome, serving as a proxy for treatment effectiveness.

Clinical Implications

Clinicians can consider both cycling TNFi and switching to IL-17i as viable second-line options after initial TNFi failure in PsA, with retention rates serving as an important effectiveness measure. The choice may be influenced by patient-specific factors such as HLA-B27 status and disease phenotype. Real-world data support individualized treatment strategies to optimize persistence and outcomes.

Conclusion

This real-world analysis provides valuable insights into treatment retention following first-line TNFi failure in PsA, highlighting comparable baseline characteristics and the importance of retention as a clinical endpoint. Further detailed outcome data will inform optimal sequencing strategies.

References

  1. EULAR Guidelines 2022 -- Management of Psoriatic Arthritis
  2. Sandri et al. 2021 -- Retention Rates of TNFi vs IL-17i in PsA
  3. BIologics Retention Rate Assessment (BIRRA) Project Protocol

Original Source(s)

Efficacy Comparison of Cycling Versus Transitioning to IL-17 Inhibitors Following Initial TNF Inhibitor Failure in Psoriatic Arthritis: A Multicenter Real-World Analysis

  • by 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

  • November 24, 2025

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