POS0266 CYCLING VS SWAP TNFi AND IL17i IN PSORIATIC ARTHRITIS: RESULTS FROM THE BIRRA RETROSPECTIVE OBSERVATIONAL STUDY

Background: In the last years, there was a dramatic increase of advanced DMARDs for psoriatic arthritis (PsA). There are many b/tsDMARDs with different mechanisms of action (MoA) to consider after the failure of the first advanced line of therapy. As a consequence, the rheumatologists can implement a cycling (same MoA) or swap strategy. Objectives: The aim of this real world based study is to investigate if, after the failure of a TNF inhibitor (TNFi), another TNFi or an interleukin 17 inhibitor (IL17i) is the most effective choice (from a clinical practice point of view). Methods: For this retrospective observational multicenter study, PsA (according to CASPAR criteria) patients who failed a first line TNFi and subsequently received a TNFi or IL17i were enrolled. For each subject, the following characteristics were recorded: anamnestic (age, sex) and disease-related (duration, presence of axial PsA, DAPSA, advanced therapies carried out, csDMARDs and steroids association) data, treatment duration and cause of failure. Patients were divided in two groups according to the strategy used: cycling (i.e. from TNFi to TNFi) (CG) or swap (i.e from TNFi to IL17i) (SG). The Kaplan-Meier curves compared the effectiveness of the two strategies, while multivariable Cox analysis (stepwise) identified the risk factors affecting treatment retention rate. Results: 347 subjects were enrolled (M:F 160:187; age 56 years IQR 47-63). In CG and SG were 217 and 130 patients, respectively. The 5 years retention rate in SG was higher than in CG (57,8% vs 45,2%; p=0.1) (Figure 1). Taking into account the whole cohort, the factors predictive of treatment interruption were DAPSA (HR 1.03 CI95% 1.01-1.05; p=0.0009) and swap strategy (HR 0.49 CI95% 0.27-0.90; p=0.02). Conclusion: The swap strategy (i.e. from TNFi to IL17i) was the best choice in PsA patients who failed the first line of advanced treatment. This finding supports the hypothesis that changing the MoA can improve the chances to identify the most effective PsA treatment. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Alarico Ariani Amgen, Janssen, Federica Lumetti: None declared, Simone Parisi: None declared, Olga Addimanda: None declared, BERND RAFFEINER: None declared, Alberto Lo Gullo: None declared, Rosario Foti: None declared, Antonella Farina: None declared, Francesco Girelli: None declared, Maddalena Larosa Abbvie, Amgen, UCB, Romina Andracco: None declared, Marino Paroli: None declared, Patrizia Del Medico: None declared, Aldo Molica Colella: None declared, Marta Priora: None declared, Aurora Ianniello: None declared, Francesca Ometto: None declared, Elena Bravi: None declared, Alessandra Bezzi: None declared, Palma Scolieri: None declared, Rosetta Vitetta: None declared, Alessandro Volpe: None declared, Massimo Reta: None declared, Mirco Magnani: None declared, Elisa Visalli: None declared, Giorgio Amato: None declared, Francesco De Lucia: None declared, Roberta Foti: None declared, Simone Bernardi: None declared, Dario Camellino: None declared, Gerolamo Bianchi: None declared, Natalia Mansueto: None declared, Giulio Ferrero: None declared, Rosalba Caccavale: None declared, Veronica Franchina: None declared, FRANCESCO MOLICA COLELLA: None declared, Gilda Sandri: None declared, Carlo Salvarani: None declared, Dilia Giuggioli: None declared, Francesca Serale: None declared, Valeria Nucera: None declared, Cecilia Giampietro: None declared, Eleonora Di Donato: None declared, Giuditta Adorni: None declared, Gianluca Lucchini: None declared, Daniele Santilli: None declared, Ilaria Platè: None declared, Eugenio Arrigoni: None declared, Maria Cristina Focherini: None declared, Fabio Mascella: None declared, Vincenzo Bruzzese: None declared, Enrico Fusaro: None declared, Maria Chiara Ditto: None declared, Alessia Fiorenza: None declared, Guido Rovera: None declared, Antonio Marchetta: None declared, Andrea Becciolini: None declared.