ArticleRMD open2025
Cycle versus swap strategy after TNFi discontinuation in psoriatic arthritis and axial spondyloarthritis: a quasi-experimental study.
Article in RMD open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Real-World Upadacitinib Persistence and Clinical Outcomes Among Canadian Patients with Inflammatory Arthritis from a Patient Support Program: The UPRAISE Study.Rheumatology and therapy · 2026Article
- Cycling or Swapping in Spondyloarthritis? Current Knowledge.Mediterranean journal of rheumatology · 2026Review
- Navigating the Journey in Psoriatic Arthritis: Matching the Right Patient, the Right Drug, and the Right Time.Journal of clinical medicine · 2025Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo compare a bDMARD mode of action cycle vs swap treatment strategy in patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) after first tumour necrosis factor inhibitor (TNFi) discontinuation.
methodsIn December 2019, our local treatment protocol for PsA and axSpA changed from a cycle strategy (first TNFi to second TNFi) to a swap strategy (first TNFi to IL-17i). We performed a retrospective comparison of the 3-year drug retention rate using multivariable Cox regression (ref: cycle group) and disease activity (DAS28-CRP for PsA, BASDAI for axSpA) in patients with a clinical diagnosis of PsA and axSpA. For subgroup analyses, Cox regression models were stratified by sex, reason of first TNFi discontinuation, and (non-)radiographic status in axSpA.
resultsIn PsA patients (n=406), there was no overall significant difference in drug retention between strategies (HR: 1.17 (95% CI: 0.87 to 1.58), p=0.29), but male PsA patients had a significant higher risk for treatment discontinuation following a swap strategy. In axSpA patients (n=335), the swap strategy was overall associated with a higher risk of treatment discontinuation (HR: 1.46 (95% CI: 1.03 to 2.07), p=0.04). Patients who discontinued their first TNFi due to inefficacy and patients diagnosed with radiographic axSpA were at significant higher risk for treatment discontinuation following a swap strategy. No significant differences in disease activity were found for treatment strategies in PsA or axSpA.
conclusionIn PsA, the cycle and swap treatment strategy performed similarly, while in axSpA, the cycle strategy was associated with a significant higher drug retention rate.
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