A recent real-world study found that switching to an interleukin-17 (IL-17) inhibitor may lead to longer-lasting treatment success for people with psoriatic arthritis (PsA). The study looked at people who didn’t get enough relief from a tumor necrosis factor (TNF) inhibitor.

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Researchers found that people who switched to an IL-17 inhibitor were more likely to stay on their new medication over time. After one year, 78 percent of participants who switched to an IL-17 inhibitor were still taking it, compared with about 68 percent of those who tried a second TNF inhibitor.

The gap widened over time. At five years, 53 percent of those who switched to an IL-17 inhibitor remained on treatment, compared with 29 percent of those who cycled to another TNF inhibitor.

These findings suggest that if your first TNF inhibitor doesn’t control your PsA symptoms, switching to a medication that works in a different way may improve your chances of long-term disease control.

Read real-world advice about using biologics for PsA from people who know.

TNF Inhibitors vs. IL-17 Inhibitors: What’s the Difference?

Both TNF inhibitors and IL-17 inhibitors are biologics. These medications target parts of the immune system that drive inflammation in psoriatic arthritis:

• TNF inhibitors block tumor necrosis factor, a protein that plays a key role in inflammation. They have been used for many years and are often prescribed as the first biologic after other treatments don’t work.
• IL-17 inhibitors block interleukin-17, another protein involved in inflammation. IL-17 inhibitors became available more recently and work in a different way, helping calm inflammation through another pathway in the immune system.

What the Study Found

The study included 452 adults with psoriatic arthritis treated at 25 rheumatology centers in Italy. All participants had stopped their first TNF inhibitor and then switched to either another TNF inhibitor (called “cycling”) or an IL-17 inhibitor (called “swapping”).

Higher Treatment Retention With IL-17 Inhibitors

Researchers measured treatment retention, meaning how long people stayed on their new medication. Staying on treatment is often used as a sign that the medication is helping and is tolerable.

After 12 months, treatment retention rates were:

• 78 percent for those who switched to an IL-17 inhibitor
• 68.3 percent for those who tried another TNF inhibitor

The differences became even more noticeable over time. At three and five years, people who switched to an IL-17 inhibitor were more likely to remain on therapy.

At 36 months (three years), retention rates were:

• 59.6 percent for those who switched to an IL-17 inhibitor
• 39.3 percent for those who cycled to another TNF inhibitor

At 60 months (five years), retention rates were:

• 53.5 percent for the IL-17 group
• 28.8 percent for the TNF-cycling group

In statistical analyses, switching to an IL-17 inhibitor was the only factor clearly linked to longer treatment persistence.

What These Findings Mean for People Living With PsA

For many people with PsA, finding the right treatment can take time. It’s not uncommon for a first biologic to stop working or not provide enough relief.

This study adds real-world evidence suggesting that switching to a biologic that works in a different way — such as moving from a TNF inhibitor to an IL-17 inhibitor — may improve the chances of staying on treatment long term. As the authors noted, the findings support the idea that a “swap strategy” may provide longer-lasting disease control for some people.

That said, treatment decisions are highly personal. PsA can affect joints, skin, spine, and other parts of the body differently for each person. What works well for one person may not work the same way for someone else.

If your current treatment isn’t meeting your needs — whether because of side effects, ongoing symptoms, or changes over time — consider talking with your rheumatologist. You might ask:

• What are my options if this medication stops working?
• Would switching to a different type of biologic make sense for me?
• How will we measure whether a new treatment is working?

Working closely with your healthcare provider can help you weigh the potential benefits and risks of different approaches and find a treatment plan that fits your goals and lifestyle.

Join the Conversation

On MyPsoriasisTeam, people share their experiences with psoriasis and psoriatic arthritis, get advice, and find support from others who understand.

Have you switched from one biologic treatment to another? Let others know in the comments below.