Background: Advanced therapies such as interleukin (IL)-23, IL-12/23, IL-17, phosphodiesterase-4 (PDE-4), and tumor necrosis factor (TNF) inhibitors (i) have been approved for 1 ^st line treatment of active psoriatic arthritis (PsA). Treatment goals for PsA include achieving the lowest possible disease activity, optimizing functional status, and avoiding treatment complications. A treatment switch is recommended when those goals are unmet.

Objectives: The study aimed to evaluate the real-world switching patterns among patients with PsA taking 1 ^st line advanced therapies (1LAT) over 12 months.

Methods: Adults with ≥1 PsA diagnosis in baseline who initiated a new 1LAT between 1/21/22 and 1/31/23 were identified using the MerativeTM Marketscan® databases covering 1/1/16 to 1/31/24. Patients had ≥6 months of continuous enrollment pre-index date (baseline) and ≥12 months of continuous enrollment post-index date. Switching was defined as the proportion of patients who switched to a new advanced therapy in the 12-month follow-up after treatment initiation. Multivariate logistic regression was used to compare switching when accounting for differences in baseline characteristics. Switching was evaluated for the overall population, stratified by the mechanism of action (MOA; reference IL-23i) and individual drugs (reference: risankizumab (RZB)).

Results: A total of 1309 patients were included in the analysis. Baseline characteristics were similar between MOAs. Overall, 24.2% of patients switched therapies over 12 months. Switching was least common in patients initiating IL-23i (8.1%) compared to TNFi (31.5%), IL-17i (19.9%), and PDE-4i (26.9%). Compared to IL-23i, the odds of switching were 5.22 (95% CI 3.15-8.67), 4.11 (95% CI 2.43-6.96), and 2.75 (95% CI 1.53-4.96) for TNFi, PDE-4i, and IL-17i, respectively (all P<0.001). RZB was associated with significantly lower proportion of switchers (3.8%) than guselkumab (12.9%), followed by secukinumab (18.8%), ixekizumab (20.8%), apremilast (26.9%), etanercept (30.0%) and adalimumab (32.4%) (all P<0.05). Compared to RZB, the odds of treatment switch were 11.87 (95% CI 4.68-30.11), 10.77 (95% CI 3.91-29.68), 8.87 (95% CI 3.48-22.56), 6.46 (95% CI 2.33-17.91), 5.52 (95% CI 1.91-15.94), and 3.79 (95% CI 1.33-10.82) for adalimumab, etanercept, apremilast, ixekizumab, secukinumab, and guselkumab, respectively (all P<0.05).

Conclusion: The proportion of PsA patients taking 1LAT who switched over 12 months was the lowest with IL-23i. At the individual drug level, RZB was associated with the lowest odds of switching.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: Jessica A. Walsh AbbVie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, AbbVie, Merck, Pfizer, Jashin Wu AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Bausch Health, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Codex Labs, Dermavant, DermTech, Dr. Reddy’s Laboratories, Eli Lilly, EPI Health, Galderma, Incyte, Janssen, LEO Pharma, Mindera, Novartis, Pfizer, Regeneron, Samsung Bioepis, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, and Zerigo Health, AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Bausch Health, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Codex Labs, Dermavant, DermTech, Dr. Reddy’s Laboratories, Eli Lilly, EPI Health, Galderma, Incyte, Janssen, LEO Pharma, Mindera, Novartis, Pfizer, Regeneron, Samsung Bioepis, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, and Zerigo Health, Xiaolan Ye Full-time salaried employee of AbbVie and may own stock/options, Full-time salaried employees of AbbVie and may own stock/options, Manish Patel AbbVie and may own stock/options, AbbVie and may own stock/options, Chao Li AbbVie and may own stock/options, AbbVie and may own stock/options, Christopher D Saffore AbbVie and may own stock/options, AbbVie and may own stock/options, Jamie Vora AbbVie and may own stock/options, AbbVie and may own stock/options, Alexis Ogdie Is or a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Eli Lilly, Janssen, Novartis, and Pfizer.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.