Switching Between Biological Treatments in Psoriatic Arthritis: A Review of the Evidence

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy. Therapy with anti-tumor necrosis factor (TNF)-alpha agents represents the first therapeutic choice for moderate and severe forms; however, PsA patients can experience anti-TNF alpha failure, lack of efficacy, or adverse events. Several evidences exist on the effectiveness of switching among different TNF alpha inhibitors, and we reviewed the published data on the effectiveness of anti-TNF alpha first-, second- and third-line. Most of the studies report that the main reason for switching to a second anti-TNF alpha agent is represented by lack of efficacy (primary or secondary) and, more rarely, adverse events. Switchers receiving their second anti-TNF alpha agent have considerably poorer responses compared with non-switchers. Survival of anti-TNF alpha treatment appears to be superior in PsA patients when compared with rheumatoid arthritis patients. Switching from anti-TNF agents to ustekinumab or secukinumab or apremilast can represent a valid alternative therapeutic strategy.