Dual biologic therapy linked with clinical improvements in Crohn’s
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Treatment with dual biologic therapy was associated with clinical and endoscopic improvements in patients with Crohn’s disease who previously failed multiple biologics, according to study results.
Robert Battat, MD, of the Jill Roberts Center for Inflammatory Bowel Disease at Weill Cornell Medicine, and colleagues wrote that many patients still fail to achieve prolonged clinical remission even with recent improvement to biologic IBD therapies.
“Despite the safety of newer biologics, simultaneous treatment with two biologic medications is rarely utilized,” they wrote. “It remains unknown if concomitant use of these newer biologics with one another or with a TNF-antagonist would increase the overall risk for infectious complications compared with current standard of care.”
Researchers identified 23 therapeutic trials comprising 22 patients with CD who started dual biologic therapy. The patients had a failed median number of four biologics, and 91% had prior surgical resections.
The primary outcome of the study was endoscopic improvement, defined by a greater than 50% reduction in Simplified Endoscopic Score-CD (SES-CD). Researchers also assessed endoscopic remission, clinical response, clinical remission and C-reactive protein levels.
Battat and colleagues found that 43% of trials achieved endoscopic improvement and 26% achieved clinical remission, while 50% achieved clinical response and 41% achieved clinical remission.
Additionally, there were post-treatment reductions in SES-CD (14 [12-17.5] to 6 [2.5-8.0]; P = .0005), and CRP (17 [11-24] to 9 [4-14]; P = .02), and perianal fistulas decreased from 50% to 33%. Investigators also found that adverse events occurred in 13% of trials.
“Dual biologic therapy was associated with clinical, biomarker and endoscopic improvements in a highly selective cohort with refractory Crohn's disease who have failed multiple biologics,” Battat and colleagues wrote. “While our findings appear promising, additional real-world reports and randomized controlled trial data will assist in determining the efficacy and safety of dual biologic therapy in refractory Crohn's disease.”
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