Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS)

RMD Open. 2022 Dec;8(2):e002681. doi: 10.1136/rmdopen-2022-002681.


Introduction: Tumour necrosis factor inhibitor (TNFi) agents are most often the first-choice biological treatment for patients with psoriatic arthritis (PsA). When their discontinuation is needed, a switch to another TNFi or to another therapeutic class may be considered. However, data supporting one approach over another are lacking.

Objective: To compare the long-term persistence of classes of biologics in PsA patients with prior TNFi exposure.

Methods: This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database. We included all adults with PsA starting a second-line biological after discontinuing a TNFi during 2015-2020. Persistence was defined as the time from biological initiation to discontinuation and was estimated by the Kaplan-Meier method. Comparison of persistence by biological class was performed with Poisson regression models with time divided into 6-month intervals.

Results: We included 2975 patients: 1580 (53%) initiating a second TNFi, 426 (14%) an interleukin 12/23 inhibitor (IL-12/23i) and 969 (33%) an IL-17 inhibitor (IL-17i). Overall, 1-year and 3-year persistence rates were 42% and 17%, respectively. After adjustment, persistence was associated with treatment with an IL-17i (adjusted relative risk (RRa) 0.79, 95% CI 0.71 to 0.87) or IL-12/23i (RRa 0.69, 95% CI 0.61 to 0.79) vs a TNFi, with no significant difference between IL-12/23 and IL-17 inhibitors (RRa 0.88, 95% CI 0.76 to 1.02).

Conclusions: Overall, this real-life study shows low persistence for all biologics at 3 years in PsA patients previously exposed to a TNFi. However, persistence was higher with an IL-17i or IL-12/23i than a TNFi.

Keywords: arthritis, psoriatic; biological therapy; tumor necrosis factor inhibitors.

MeSH terms

  • Adult
  • Antirheumatic Agents* / therapeutic use
  • Arthritis, Psoriatic* / drug therapy
  • Arthritis, Psoriatic* / epidemiology
  • Biological Factors / therapeutic use
  • Biological Products* / adverse effects
  • Cohort Studies
  • Humans
  • Insurance, Health
  • Interleukin-12
  • Interleukin-17
  • Treatment Outcome
  • Tumor Necrosis Factor Inhibitors / therapeutic use


  • Tumor Necrosis Factor Inhibitors
  • Antirheumatic Agents
  • Interleukin-17
  • Biological Factors
  • Biological Products
  • Interleukin-12