Retention rate of TNF inhibitors versus IL-17 inhibitors in ankylosing spondylitis patients with prior biologics experience
Abstract Background For patients with ankylosing spondylitis (AS) who experience inefficacy or adverse events with biologics, no recommendations exist regarding the preference for class cycling or switching as a second- or higher-line biologics. Previous studies on the drug retention of TNF and IL-1...
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BMC
2025-07-01
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| Series: | Arthritis Research & Therapy |
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| Online Access: | https://doi.org/10.1186/s13075-025-03601-z |
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| author | Jiwon Yang Bong-Woo Lee Youngjae Park Ji Hyeon Ju Wan-Uk Kim Sung-Hwan Park Seung-Ki Kwok Jennifer Jooha Lee |
| author_facet | Jiwon Yang Bong-Woo Lee Youngjae Park Ji Hyeon Ju Wan-Uk Kim Sung-Hwan Park Seung-Ki Kwok Jennifer Jooha Lee |
| author_sort | Jiwon Yang |
| collection | DOAJ |
| description | Abstract Background For patients with ankylosing spondylitis (AS) who experience inefficacy or adverse events with biologics, no recommendations exist regarding the preference for class cycling or switching as a second- or higher-line biologics. Previous studies on the drug retention of TNF and IL-17 inhibitors in AS patients with prior biologics exposure have limitations, including relatively short follow-up periods, exclusion of patients with extra-articular manifestations, and a primary focus on second-line treatment. This study aimed to compare the retention rates of TNF and IL-17 inhibitors in AS patients with prior biologics experience, over a relatively longer follow-up period in real clinical practice. Methods A total of 148 AS cases receiving either a TNF or IL-17 inhibitor as a second- or higher-line biologic were retrospectively analyzed after propensity score matching. Patient characteristics at the time of cycling or switching and drug retention were compared between the two groups. Subgroup analyses were conducted based on the reasons for drug discontinuation. Cox regression analyses were used to identify the factors associated with drug discontinuation. Results The median follow-up period was 31.4 months, and drug survival tended to be lower for IL-17 inhibitors than for TNF inhibitors in the Kaplan–Meier analysis (P = 0.134). The lower retention of IL-17 inhibitors was more pronounced when discontinuations unrelated to treatment failure were censored (P = 0.034) or when used for reasons other than psoriasis aggravation (P = 0.028). However, in multivariable Cox regression, the number of previous biologics (HR: 1.62, 95% CI: 1.17–2.23, P = 0.003) and BASDAI (HR: 1.3, 95% CI: 1.03–1.65, P = 0.030) were significantly associated with drug discontinuation, whereas the class of biologics did not reach statistical significance (HR: 2.11, 95% CI: 0.96–4.63, P = 0.064). Conclusion In patients with AS who had prior experience with biologics, the drug retention of TNF inhibitors tended to be higher compared to IL-17 inhibitors in real-world clinical practice. However, the factors significantly associated with higher drug survival were a lower number of previously exposed biologics and a lower BASDAI. |
| format | Article |
| id | doaj-art-cb8bee17b93c44f0bddee998609c549d |
| institution | Kabale University |
| issn | 1478-6362 |
| language | English |
| publishDate | 2025-07-01 |
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| series | Arthritis Research & Therapy |
| spelling | doaj-art-cb8bee17b93c44f0bddee998609c549d2025-08-20T03:45:31ZengBMCArthritis Research & Therapy1478-63622025-07-012711910.1186/s13075-025-03601-zRetention rate of TNF inhibitors versus IL-17 inhibitors in ankylosing spondylitis patients with prior biologics experienceJiwon Yang0Bong-Woo Lee1Youngjae Park2Ji Hyeon Ju3Wan-Uk Kim4Sung-Hwan Park5Seung-Ki Kwok6Jennifer Jooha Lee7Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaDivision of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaDivision of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaDivision of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaDivision of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaDivision of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaDivision of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaDivision of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaAbstract Background For patients with ankylosing spondylitis (AS) who experience inefficacy or adverse events with biologics, no recommendations exist regarding the preference for class cycling or switching as a second- or higher-line biologics. Previous studies on the drug retention of TNF and IL-17 inhibitors in AS patients with prior biologics exposure have limitations, including relatively short follow-up periods, exclusion of patients with extra-articular manifestations, and a primary focus on second-line treatment. This study aimed to compare the retention rates of TNF and IL-17 inhibitors in AS patients with prior biologics experience, over a relatively longer follow-up period in real clinical practice. Methods A total of 148 AS cases receiving either a TNF or IL-17 inhibitor as a second- or higher-line biologic were retrospectively analyzed after propensity score matching. Patient characteristics at the time of cycling or switching and drug retention were compared between the two groups. Subgroup analyses were conducted based on the reasons for drug discontinuation. Cox regression analyses were used to identify the factors associated with drug discontinuation. Results The median follow-up period was 31.4 months, and drug survival tended to be lower for IL-17 inhibitors than for TNF inhibitors in the Kaplan–Meier analysis (P = 0.134). The lower retention of IL-17 inhibitors was more pronounced when discontinuations unrelated to treatment failure were censored (P = 0.034) or when used for reasons other than psoriasis aggravation (P = 0.028). However, in multivariable Cox regression, the number of previous biologics (HR: 1.62, 95% CI: 1.17–2.23, P = 0.003) and BASDAI (HR: 1.3, 95% CI: 1.03–1.65, P = 0.030) were significantly associated with drug discontinuation, whereas the class of biologics did not reach statistical significance (HR: 2.11, 95% CI: 0.96–4.63, P = 0.064). Conclusion In patients with AS who had prior experience with biologics, the drug retention of TNF inhibitors tended to be higher compared to IL-17 inhibitors in real-world clinical practice. However, the factors significantly associated with higher drug survival were a lower number of previously exposed biologics and a lower BASDAI.https://doi.org/10.1186/s13075-025-03601-zAnkylosing spondylitisTNF inhibitorsIL-17 inhibitorsBiologicsSecond or higher lineDrug retention |
| spellingShingle | Jiwon Yang Bong-Woo Lee Youngjae Park Ji Hyeon Ju Wan-Uk Kim Sung-Hwan Park Seung-Ki Kwok Jennifer Jooha Lee Retention rate of TNF inhibitors versus IL-17 inhibitors in ankylosing spondylitis patients with prior biologics experience Arthritis Research & Therapy Ankylosing spondylitis TNF inhibitors IL-17 inhibitors Biologics Second or higher line Drug retention |
| title | Retention rate of TNF inhibitors versus IL-17 inhibitors in ankylosing spondylitis patients with prior biologics experience |
| title_full | Retention rate of TNF inhibitors versus IL-17 inhibitors in ankylosing spondylitis patients with prior biologics experience |
| title_fullStr | Retention rate of TNF inhibitors versus IL-17 inhibitors in ankylosing spondylitis patients with prior biologics experience |
| title_full_unstemmed | Retention rate of TNF inhibitors versus IL-17 inhibitors in ankylosing spondylitis patients with prior biologics experience |
| title_short | Retention rate of TNF inhibitors versus IL-17 inhibitors in ankylosing spondylitis patients with prior biologics experience |
| title_sort | retention rate of tnf inhibitors versus il 17 inhibitors in ankylosing spondylitis patients with prior biologics experience |
| topic | Ankylosing spondylitis TNF inhibitors IL-17 inhibitors Biologics Second or higher line Drug retention |
| url | https://doi.org/10.1186/s13075-025-03601-z |
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