# 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.

## Key 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.