Combining different biologic drugs
The availability of several biologic drugs for the treatment of IBD offers the possibility to combine these agents and simultaneously antagonise different pathways, potentially resulting in an additive or synergistic effects for refractory disease.
Combination treatment with a TNF antagonist and vedolizumab [anti-integrin] is particularly attractive because it includes a rapidly acting systemic agent and a slower acting gut-specific therapy. The first case reports and case series suggest that this combination has an acceptable safety profile and could be particularly useful in patients treated with TNF antagonists who have insufficient intestinal disease control but well-controlled extra-intestinal manifestations.94,95 One ongoing RCT is currently investigating the potential effect of triple therapy with vedolizumab, adalimumab, and oral MTX on endoscopic remission in newly-diagnosed CD patients at high risk for complications [NCT02764762].
We are aware of one small case series on the combination of a TNF antagonist and ustekinumab [three subcutaneous injections: 90 mg, 45 mg, and 45 mg, respectively] for paradoxical psoriasis resistant to topical therapy and MTX in patients with IBD in remission.96 The combination therapy, although not effective on the cutaneous lesions, did not result in short-term AEs and was well tolerated.
https://academic.oup.com/ecco-jcc/article/12/1/105/4093864
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