Combination therapy with TNF inhibitors plus biologics targeting type 2 inflammatory conditions in patients with rheumatoid arthritis: a case series

TL;DR

This case series explores combining TNF inhibitors with biologics targeting type 2 inflammation in rheumatoid arthritis patients, finding no increase in infections and potential reduction in steroid use.

Contribution

The study provides the first case series on combination biologic therapy for type 1 and 2 inflammation in rheumatoid arthritis.

Findings

Combination therapy did not increase bacterial infections in patients.

Corticosteroid use decreased after starting dual biologic agents.

Patients remained on combination therapy for an average of 83.7 weeks.

Abstract

Patients with RA treated with TNF inhibitors (TNFis) may experience type 2 inflammatory conditions such as asthma, atopic dermatitis or urticaria. Multiple biologic agents targeting type 2 inflammation are available. Combination biologic therapy targeting types 1 and 2 inflammation is not well described. We present a series of patients on a combination TNFi and biologic agent targeting type 2 inflammation.

A retrospective case series of RA patients on TNFi receiving a biologic agent for type 2 inflammatory conditions was compiled. Descriptive data, duration of biologic use, incident bacterial infections and corticosteroid used 6 months before and after combination biologic agent use was collected.

Twelve patients were included. The mean overlap of combination biologic therapy was 83.7 weeks (95% CI 56.0, 111.4) and the median was 92.6 weeks [interquartile range (IQR) 36.4–109.8]. The mean corticosteroid cumulative dose 6 months prior to dual biologic agents was 463 mg prednisone equivalent (95% CI 131, 795) and the median was 265 mg (IQR 75–570). The mean corticosteroid cumulative dose 6 months after dual biologic agents was 241 mg prednisone equivalent (95% CI −21, 503) and the median was 0 mg (IQR 0–275). Six bacterial infections occurred prior to combination biologic therapy compared with five after initiating dual biologics.

This case series demonstrates that adding a second biologic agent to target type 2 inflammatory conditions in RA patients on TNFi did not increase incident bacterial infections and may decrease corticosteroid use.

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