Role of TNF-alpha Inhibitors in PsA

Some of this strategy pays off when we cycle biologics, when someone fails, most commonly a TNF, we change the mechanism of action and we go back to a TNF, and generally this strategy works. How much did some of the early TNFs benefit from these newest agent studies that have comparator arms or head to head, all of a sudden we know, hey, enthesitis and dactylitis, the way it was meant to be looked at, as opposed to 2003, where it's kind of this gestalt. What came out of that besides the statistically significant improvement in the ACR scores, complete resolution of dactylitis and enthesitis, they were able to show inhibition of radiographic progression, a slight dose-dependent improvement on the 300-mg arm.