POS0278 COMPARISON OF CYCLE VERSUS SWAP TREATMENT STRATEGY ON DRUG RETENTION AND DISEASE ACTIVITY AFTER TNFi FAILURE IN PSORIATIC ARTHRITIS: A QUASI-EXPERIMENTAL STUDY

Background: Patients with psoriatic arthritis (PsA) who initiate a biological disease-modifying antirheumatic drugs (bDMARD) often experience loss of effectiveness or side effects. The EULAR and GRAPPA treatment guidelines then recommend to start another bDMARD, but without preference for cycling within the same bDMARD class or swapping to another mode of action. In the Sint Maartenskliniek (SMK), the Netherlands, the local drug formulary recommended a cycle strategy (TNFi →TNFi) prior to 2019 and a swap strategy (TNFi →IL-17i) after 2019. This resulted in a quasi-experimental study cohort, that allowed us to compare the cycle versus swap strategy. Objectives: (1) to compare the 3-year drug retention rate and 1-year disease activity of a second TNFi (cycle) versus an IL-17i (swap) strategy and (2) to identify patient and disease characteristics associated with the efficacy of cycling versus swapping, in patients with PsA who failed a first TNFi. Methods: All patients with a clinical diagnosis of PsA who were prescribed a second TNFi or IL-17i were included from the Integral Rheumatology Information System (IRIS) of the SMK. Patients were grouped as either a cycler or a swapper. Drug retention was based on treatment failure (event) defined as discontinuation due to inefficacy or side effects. Drug retention was analyzed using Kaplan-Meier curve, log-rank test and multivariable cox regression, adjusted for the potential confounding disease and patient characteristics. The mean difference in disease activity (DAS28-CRP) between baseline, 6 months and 12 months was compared between cyclers and swappers using student's t-test. Results: In total, 406 PsA patients who have visited the SMK between 2012 and 2023 were included. Of them, 307 were cycler and 99 swapper, with similar baseline patient and disease characteristics (Table 1). Overall, 45.3% and 19.2% of the cyclers and 52.5% and 8.1% of the swappers discontinued their second-line bDMARD therapy due to inefficacy and side-effects, respectively. At 12 and 24 months, drug retention rates were 74.9% and 60.3% respectively for cyclers, and 80.8% and 55.6% for swappers. Overall, no difference in risk at treatment failure was seen between swappers and cyclers (HR adjusted for sex and discontinuation reason first TNFi: 1.19 (95% CI: 0.89 – 1.60), p = 0.24) (Figure 1). Notably, in male PsA patients, swapping resulted in a significant higher risk of treatment failure (HR adjusted for discontinuation reason first TNFi: 1.67 (95% CI: 1.06 – 2.62), p = 0.03 compared to HR adjusted for discontinuation reason first TNFi: 0.99 (95% CI: 0.67 – 1.47), p = 0.96 for female PsA patients). At 6 months, the mean DAS28-CRP score was 2.80 (sd: 1.13) for cyclers and 2.69 (sd: 0.95) for swappers and at 12 months, this was 2.65 (sd: 1.11) and 2.51 (sd: 0.96) for cyclers and swappers respectively. There were no significant differences in mean difference in DAS28-CRP between cyclers and swappers at any timepoint. Conclusion: After failure to a first TNFi in patients with PsA, there was no difference in cycle versus swap to IL17i strategy with respect to drug retention rate or disease activity. Interestingly, in male PsA patients a cycle strategy had a longer drug retention rate compared to a swap (IL-17i) strategy. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Ilse van Es: None declared, Johanna E. Vriezekolk Received funding for research grants from Novartis and Eli Lilly, unrelated to work presented in the current abstract, Nathan den Broeder: None declared, Lisan de Beijer: None declared, A.A. den Broeder Received grants for research and quality of care projects to the institution from Lilly, Abbvie, Galapagos, Novartis, Pfizer, Gilead, Sanofi, Biogen and Celltrion., Noortje van Herwaarden: None declared, E.A.M. Mahler Received grants for research and quality of care projects to the institution from Abbvie, Eli Lilly, Pfizer, Novartis, unrelated to work presented in the current abstract., Emmerik F.A. Leijten Received funding for research grants from Novartis and Eli Lilly, unrelated to work presented in the current abstract.