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Introduction <p>Tumor necrosis factor inhibitors (TNFis) are a common first-line treatment option for patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) with persistent disease activity despite conventional treatment. There is limited real-world evidence available to inform selection of therapy after first TNFi failure.</p> Methods <p>This study compares the effectiveness of cycling to a second TNFi versus switching to an interleukin-17A inhibitor (IL-17Ai) at 6-month follow-up, among patients with PsA and axSpA who discontinued a first TNFi. Patients were stratified into two groups: those who (1) initiated a second TNFi (cyclers) and (2) initiated an IL-17Ai (switchers). Inverse probability of treatment weighting (IPTW) was used to account for baseline differences between cyclers and switchers. Separate models were fit for the PsA and axSpA cohorts.</p> Results <p>The PsA cohort included 277 (59%) cyclers and 194 (41%) switchers. Prior to IPTW, switchers demonstrated greater improvement (− 4.1 [95% confidence interval (CI) − 5.6, − 2.5]) in the primary outcome of change from baseline (CFB) in the Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) versus cyclers. Post IPTW, switchers showed greater improvements across most secondary outcomes, and significantly greater improvements in Physician Global Assessment (PhGA) of arthritis and psoriasis (− 5.0 [95%&#xa0;CI − 9.3, − 0.8], <i>p</i> = 0.021) and non-work activity impairment (− 4.7 [95%&#xa0;CI − 9.2, − 0.2], <i>p</i> = 0.039).</p> <p>The axSpA cohort included 119 (69%) cyclers and 53 (31%) switchers. Prior to IPTW, switchers demonstrated greater improvement (− 0.7 [95%&#xa0;CI − 1.2, − 0.2]) in the primary outcome of CFB in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) versus cyclers. Post IPTW, switchers showed significantly greater improvement in patient fatigue (− 9.4 [95%&#xa0;CI − 15.8, − 3.1], <i>p</i> = 0.004) and numerically greater improvements across remaining secondary outcomes.</p> Conclusion <p>Switching to IL-17Ai vs. cycling to another TNFi provided similar or numerically improved outcomes in both cohorts, underscoring the importance of considering alternative mechanisms of action for these patients.</p>

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Cycling to TNFi vs. Switching to IL-17Ai Among Patients with Psoriatic Arthritis and Axial Spondyloarthritis: Real-World CorEvitas PsA/SpA Registry Data

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月12日

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  • Alexis Ogdie,
  • Nicole Middaugh,
  • Maya Marchese,
  • Jessica A. Walsh,
  • Natalia Bello,
  • Marcus Ngantcha,
  • Andris Kronbergs,
  • Elsie L. Grace,
  • Philip J. Mease

摘要

Introduction

Tumor necrosis factor inhibitors (TNFis) are a common first-line treatment option for patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) with persistent disease activity despite conventional treatment. There is limited real-world evidence available to inform selection of therapy after first TNFi failure.

Methods

This study compares the effectiveness of cycling to a second TNFi versus switching to an interleukin-17A inhibitor (IL-17Ai) at 6-month follow-up, among patients with PsA and axSpA who discontinued a first TNFi. Patients were stratified into two groups: those who (1) initiated a second TNFi (cyclers) and (2) initiated an IL-17Ai (switchers). Inverse probability of treatment weighting (IPTW) was used to account for baseline differences between cyclers and switchers. Separate models were fit for the PsA and axSpA cohorts.

Results

The PsA cohort included 277 (59%) cyclers and 194 (41%) switchers. Prior to IPTW, switchers demonstrated greater improvement (− 4.1 [95% confidence interval (CI) − 5.6, − 2.5]) in the primary outcome of change from baseline (CFB) in the Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) versus cyclers. Post IPTW, switchers showed greater improvements across most secondary outcomes, and significantly greater improvements in Physician Global Assessment (PhGA) of arthritis and psoriasis (− 5.0 [95% CI − 9.3, − 0.8], p = 0.021) and non-work activity impairment (− 4.7 [95% CI − 9.2, − 0.2], p = 0.039).

The axSpA cohort included 119 (69%) cyclers and 53 (31%) switchers. Prior to IPTW, switchers demonstrated greater improvement (− 0.7 [95% CI − 1.2, − 0.2]) in the primary outcome of CFB in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) versus cyclers. Post IPTW, switchers showed significantly greater improvement in patient fatigue (− 9.4 [95% CI − 15.8, − 3.1], p = 0.004) and numerically greater improvements across remaining secondary outcomes.

Conclusion

Switching to IL-17Ai vs. cycling to another TNFi provided similar or numerically improved outcomes in both cohorts, underscoring the importance of considering alternative mechanisms of action for these patients.