POS0112 CYCLING VERSUS SWAPPING STRATEGIES AFTER TNF INHIBITORS FAILURE IN PSORIATIC ARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background:

Psoriatic arthritis (PsA) is commonly treated with one biologic Disease-Modifying Antirheumatic Drug (bDMARD), usually Tumor Necrosis Factor inhibitor (TNFi) due to its cost effectiveness. In clinical practice, following failure of one bDMARD, it is normal to consider which options are the best for switching strategy. However, the effectiveness of swapping compared to the cycling strategy in PsA with previous treatment failure is still contentious.

Objectives:

We aimed to perform a meta-analysis exploring the cycling and swapping strategies in patients with PsA and previous treatment failure.

Methods:

PubMed, Embase and Cochrane Central database were searched for randomized controlled trials and observational studies that compared cycling (switching from one bDMARD to another with the same mechanism of action) and swapping (switching from one bDMARD to another with different mechanism of action) in PsA patients with previous treatment failure and reported the following outcomes: (1) lack of response; (2) retention rate at 12 months; (3) retention rate at 24 months; and (4) adverse events. We computed hazard ratio (HR) or risk ratio (RR) for binary endpoints, with 95% confidence intervals (CI). Heterogeneity was examined with I² statistics. A random-effects model was used for outcomes with high heterogeneity.

Results:

A total of four observational studies were analyzed, comprising 1,073 patients with PsA, of whom 772 (71.95%) were in the cycling group (CG) and 301 (28.05%) in the swapping (SG). PsA duration until the use of the second bDMARD ranged from 3.7 to 9 years. The main cause of treatment failure was ineffectiveness over time, with no significant difference between groups (RR 1.12; 95% CI 0.79-1.59; p=0.51; I²=55%) (Figure 1C). Compared with SG, there was no statistical increase in the retention rates at 12 months (RR 0.98; 95% CI 0.88-1.10; p=0.76; I²=27%) (Figure 1B) and at 24 months (HR 0.93; 95% CI 0.53-1.63; p=0.79; I²=74%) (Figure 1A) in the CG. There were no differences between the treatment strategies regarding the adverse events endpoint (10.36% vs 6.31%; RR 1.23; 95% CI 0.44-3.46; p=0.7; I²=64%) (Figure 1D).

Conclusion:

In this meta-analysis, after the failure of first bDMARD, there was no difference in cycling vs swapping strategy with respect to drug retention rate at 12 and 24 months or adverse events. Both strategies appear similarly effective, supporting individualized treatment decisions. Figure 1Forest plots for outcomes- 1A) Retention rate at 24 months, 1B) Retention rate at 12 months, 1C) Ineffectiveness to 2^nd bDMARD, 1D) Adverse events.

REFERENCES:

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Acknowledgements:

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Disclosure of Interests:

None declared. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.