#2-75E. Optimizing Second-Line Biologics: Swap to IL-17i Offers Better Retention in PsA (BMC Rheumatol, 2025)

When a patient with Psoriatic Arthritis (PsA) experiences failure with their initial Tumor Necrosis Factor inhibitor (TNFi), rheumatologists face a critical decision: should they cycle to a second TNFi or swap to an alternative mechanism of action (MoA)? This retrospective, real-world multicenter study, utilizing data from 25 Italian centers, compared these two sequential strategies by assessing treatment retention rates as a proxy for effectiveness. The primary finding is that the swap strategy (TNFi to IL-17i) showed a statistically significant and persistently higher treatment retention rate compared to the cycling strategy (TNFi to TNFi) over five years (p<0.001). This robustly suggests that changing the MoA significantly improves the likelihood of achieving long-term disease control. However, for critical appraisal, a key limitation is the study’s observational nature and the lack of systematically collected psoriasis severity data (e.g., PASI scores), which introduces a potential selection bias towards IL-17i. This research is highly relevant as it provides valuable real-world evidence, guiding physicians to prioritize an IL-17i swap in second-line PsA therapy to optimize patient management and health resource utilization.

Citation: Ariani A., Larosa M., Gullo A.L. 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 Rheumatology. 2025. DOI: 10.1186/s41927-025-00587-8

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