{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:06:44Z","timestamp":1791443204489,"version":"4.3.3"},"reference-count":39,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"unspecified","delay-in-days":85,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,5,23]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In PsA, the cycle and swap treatment strategy performed similarly, while in axSpA, the cycle strategy was associated with a significant higher drug retention rate.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-005566","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T21:10:38Z","timestamp":1750885838000},"page":"e005566","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Cycle versus swap strategy after TNFi discontinuation in psoriatic arthritis and axial spondyloarthritis: a quasi-experimental study"],"prefix":"10.1136","volume":"11","author":[{"given":"Ilse","family":"van Es","sequence":"first","affiliation":[{"name":"Research, Sint Maartenskliniek, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4783-8663","authenticated-orcid":false,"given":"Johanna E","family":"Vriezekolk","sequence":"additional","affiliation":[{"name":"Research, Sint Maartenskliniek, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7126-2209","authenticated-orcid":false,"given":"Nathan","family":"den Broeder","sequence":"additional","affiliation":[{"name":"Research, Sint Maartenskliniek, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisan","family":"de Beijer","sequence":"additional","affiliation":[{"name":"Research, Sint Maartenskliniek, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfons A","family":"den Broeder","sequence":"additional","affiliation":[{"name":"Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands"},{"name":"Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9527-851X","authenticated-orcid":false,"given":"Noortje","family":"van Herwaarden","sequence":"additional","affiliation":[{"name":"Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands"},{"name":"Department of Pharmacy, Pharmacology and Toxicology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elien","family":"Mahler","sequence":"additional","affiliation":[{"name":"Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7367-0185","authenticated-orcid":false,"given":"Emmerik F A","family":"Leijten","sequence":"additional","affiliation":[{"name":"Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands"},{"name":"Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"2025090313310012000_11.2.e005566.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-022-00798-0"},{"key":"2025090313310012000_11.2.e005566.2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2024-225531"},{"key":"2025090313310012000_11.2.e005566.3","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223296"},{"key":"2025090313310012000_11.2.e005566.4","doi-asserted-by":"publisher","DOI":"10.3109\/09546634.2013.826341"},{"key":"2025090313310012000_11.2.e005566.5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kez427"},{"key":"2025090313310012000_11.2.e005566.6","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215427"},{"key":"2025090313310012000_11.2.e005566.7","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2023-003531","article-title":"Persistence and safety of anti-TNF biosimilars versus originators in immune-mediated inflammatory diseases: an observational study on the French National Health Data System","volume":"10","author":"Jourdain","year":"2024","journal-title":"RMD Open"},{"key":"2025090313310012000_11.2.e005566.8","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.131797"},{"key":"2025090313310012000_11.2.e005566.9","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-016-3425-4"},{"key":"2025090313310012000_11.2.e005566.10","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000025300","article-title":"Cycling or swap biologics and small molecules in psoriatic arthritis: Observations from a real-life single center cohort","volume":"100","author":"Ariani","year":"2021","journal-title":"Medicine (Baltimore)"},{"key":"2025090313310012000_11.2.e005566.11","unstructured":"Guimar\u00e3es F , Ferreira M , Soares C , et al . Cycling versus swapping strategies in psoriatic arthritis: results from the rheumatic diseases Portuguese register. 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