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

  • 0 min

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

At a Glance

CategoryDetail
ConditionPsoriatic Arthritis (PsA)
Key MechanismsTNF inhibitors (TNFi) and interleukin-17 inhibitors (IL-17i) as biological DMARDs with different mechanisms of action
Target PopulationPsA patients who failed first-line TNFi treatment
Care SettingRheumatology referral centers in Italy

Key Highlights

  • TNFi are first-line bDMARDs after csDMARD failure; IL-17i introduced as alternative MoA since 2016.
  • Study compares treatment retention (proxy for effectiveness) between cycling TNFi and swapping to IL-17i after first TNFi failure.
  • 452 PsA patients analyzed retrospectively from 25 centers; median follow-up 13 months; no baseline differences except HLA-B27 testing frequency.

Guideline-Based Recommendations

Diagnosis

  • PsA diagnosis according to CASPAR criteria.

Management

  • After csDMARD failure, initiate TNFi as first-line bDMARD.
  • Consider switching to IL-17i or cycling TNFi after first TNFi failure.
  • Exclude treatment changes for non-joint related reasons.

Monitoring & Follow-up

  • Assess disease activity using DAPSA for peripheral PsA and ASDAS/BASDAI for axial involvement.
  • Monitor treatment retention as a proxy for effectiveness.
  • Track reasons for treatment discontinuation including efficacy loss and adverse events.

Risks

  • Potential reduced effectiveness with repeated cycling of TNFi after multiple failures.
  • Adverse events leading to treatment discontinuation.

Patient & Prescribing Data

PsA patients who failed first-line TNFi and switched to either another TNFi or IL-17i.

Retention rate used as effectiveness proxy; switching to IL-17i may offer better retention than cycling TNFi based on prior studies.

Clinical Best Practices

  • Use standardized criteria (CASPAR) for PsA diagnosis before initiating bDMARDs.
  • Evaluate disease phenotype (peripheral, axial, mixed) and baseline activity to guide treatment choice.
  • Prefer switching to a different MoA (IL-17i) after first TNFi failure to potentially improve treatment retention.
  • Exclude patients switching bDMARDs for non-articular indications to focus on joint disease management.
  • Collect comprehensive baseline data including HLA-B27 status to inform prognosis.

References

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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