Spondyloarthritis & psoriatic arthritis
Cycle versus swap strategy after tumour necrosis factor inhibitor (TNFi) discontinuation in psoriatic arthritis and axial spondyloarthritis: a quasi-experimental study
Authors' conclusion
In PsA, the cycle and swap treatment strategy performed similarly, while in axSpA, the cycle strategy was associated with a significant higher drug retention rate.
Study context
- Population
- Patients with a clinical diagnosis of PsA or axial spondyloarthritis (axSpA) after first TNFi discontinuationPsA n=406
- Exposure
- Swap strategy vs cycle strategy after first TNFi discontinuation
- Outcome
- Drug retention rate
- Follow-up
- 3 years
Methodological detailsquasi-experimental, multivariable Cox regression
- Quasi-experimental
- Multivariable Cox regression
Main finding
As reported in the abstract
Treatment discontinuation (drug retention)
Swap vs CycleHazard ratio (95% CI)P value
PsA (n=406)
1.17(0.87–1.58)
P = 0.29axSpA (n=335)
1.46(1.03–2.07)
P = 0.04Observational data: associations, not effects.
Further findings
Treatment discontinuation, subgroups
- Male PsA patients had a significant higher risk for treatment discontinuation following a swap strategy
- axSpA patients who discontinued first TNFi due to inefficacy and those with radiographic axSpA had significant higher risk of discontinuation following a swap strategy
Disease activity (DAS28-CRP for PsA, BASDAI for axSpA)
- No significant differences between treatment strategies in PsA or axSpA
Original publication
Cycle versus swap strategy after TNFi discontinuation in psoriatic arthritis and axial spondyloarthritis: a quasi-experimental study. RMD Open. Published 25 June 2025. doi:10.
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