Emerging role of dual biologic therapy for the treatment of inflammatory bowel disease

Abstract

Biologic agents have now been used in the management of inflammatory bowel disease (IBD) for many years where experience, expertise and confidence in their use has developed over time. In the United Kingdom, there are well established guidelines and recommendations for both single agent biologic treatments, and with combination therapy of a biologic agent with a small molecule agent in maintenance therapy. In recent times, there has been increasing interest and experience using dual biologic therapy (DBT) in IBD, primarily in difficult to treat and refractory cases with high disease burden. However, published data on use, experience and safety profiles is limited and large-scale studies remain low in number in this developing area. We therefore aim to present a summary and review of the available published data in this area to help us better understand the emerging role of DBT in IBD.

Keywords: Dual biologic therapy; Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Combination therapy; Biologic safety

Core Tip: For patients with difficult to treat or refractory inflammatory bowel disease (IBD), biologic therapy and combination therapy with small molecule agents has helped improve patient outcomes and maintenance success. There is growing interest in the use of dual biologic therapy in IBD but published data remains limited. Whilst initial data suggests positive effects on reduction in morbidity, more studies are still required in this emerging area with further comparison of different biologic combinations and their safety profiles.