# Longer Drug Retention of Interleukin-12/23 or Interleukin-17 Inhibitors Compared With TNF Inhibitors in Female Patients With TNF Inhibitor-Experienced Psoriatic Arthritis

## TL;DR

In female patients with psoriatic arthritis, drugs targeting IL-12/23 or IL-17 are retained longer than TNF inhibitors, but TNF inhibitors may be better for joint symptoms.

## Contribution

This study shows that IL-12/23 or IL-17 inhibitors have longer drug retention in women with psoriatic arthritis compared to TNF inhibitors.

## Key findings

- Th17 inhibitors were discontinued later than TNF inhibitors in women (median 828 vs 445 days).
- ACR20 and ACR50 response rates were higher for TNF inhibitors despite similar disease activity improvements.
- Th17 inhibitors provided more profound skin improvement in women over time.

## Abstract

To compare the effectiveness of Interleukin (IL)-12/23 or IL-17A inhibitors (summarized to inhibitors of the Th17 cell generation or function, Th17i) with tumor necrosis factor inhibitors (TNFi) in patients with TNFi-experienced psoriatic arthritis (PsA).

We conducted a comparative effectiveness study by taking advantage of prospectively collected patients with PsA data from the Swiss Clinical Quality Management in Rheumatic Diseases register, encompassing the interval from January 1, 2015 to August 1, 2021. Drug retention was the primary outcome in unadjusted and inverse propensity-weighted Cox regression models. Secondary outcomes were a static skin score for psoriasis, the American College of Rheumatology (ACR) 20, 50, and 70 response rates, and the disease activity in PsA score.

At baseline, Th17i (n=341) were initiated in patients with more severe skin disease, but with comparable disease activity as TNFi (n=503) in all other disease domains. In the unadjusted analysis, Th17i were later discontinued than TNFi (median 828 vs 445 days, P<.001), but the hazard ratio for discontinuation was significantly lower for Th17i than for TNFi only in women (0.57 [0.37-0.87], P=.01). Furthermore, differences in static skin scores between the groups at baseline were equalized at follow-up. However, improvements in the disease activity in PsA were similar in both groups, and ACR20 (33% [29%] vs 14% [13%]; P=.03) and ACR50 response rates (24% [21%] vs 7% [6%]; P=.02) were even higher for TNFi in unadjusted and (LUNDEX-adjusted) analyses.

After TNFi failure, more profound skin improvement and longer drug retention in women argue in favor of switching to Th17i in certain patient populations. However, TNFi may at least be equivalent in improving locomotor system manifestations and remain a viable option in the first and in the later treatment line of PsA.