P740 Dual biologic therapy for patients with Inflammatory Bowel Disease in a single reference center in Spain
Diz Lois Palomares, M.T.(1)*;Porta Sánchez, Á.(2);González Conde, B.(1);Estévez Prieto, E.(1);Vázquez Rey, M.T.(1);Elberdin Pazos, L.(2);Alonso Aguirre, P.(1);Martin Herranz, I.(2);
(1)A Coruña Universitary Hospital, Gastroenterology, A Coruña, Spain;(2)A Coruña Universitary Hospital, Pharmacy Department, A Coruña, Spain;
Background
In the last 5 years, the therapeutic arsenal in IBD has been expanded. Four different groups of effective biologic/new small molecules therapies, according to the target (anti-TNF, anti-integrin, anti-IL-12/23; and JAK inhibitors), are being widely used. There is still a significant number of patients who do not respond. In the last years, in tertiary centers, two simultaneous biologic therapies have been associated in a few IBD patients in clinical practice, in order to treat two different patient profiles: patients with IBD and concurrent extraintestinal manifestations (EIMs) which did not respond to the same biologic treatment, and second, refractory-IBD patients. It seems to add efficacy in case-series. However, safety concerns limit its use. We aim to describe the 6 patients treated in a single reference center in A Coruña, Spain.
Methods
The IBD Unit in A Coruña Universitary Hospital is the reference center for a 550000 patient population. Advance therapy with biologics is centralized in this IBD Unit, with approximately 630 patients having been treated with biologic therapy. Since 2020, we have treated 6 patients with dual biologic therapy (DBT), after discussing the case in the multidisciplinar IBD-Committee and with the informed consent of the patients. We describe this case-series.
Results
Our 6 patients proposed to DBT had long-standing IBD, and presented failure to 3-5 previous advanced lines of therapy. Two had ≥ 2 previous resection surgeries, and for 3 patients the surgery option would include a permanent stoma, or high risk of short bowel syndrome because of extensive disease.
We describe in table 1 patient’s demographics, IBD characteristics, and the DBT combinations.
In table 2 we further describe DBT and response to treatment.
Main indication for DBT was refractory IBD in 5/6 patients. DBT was intensified in all these cases. It added efficacy in 2/5 cases, however without achieving deep remission. Three patients (3/5) were co-treated with steroids. One patient had a serious infectious adverse event that required hospitalisation.
In 1/6 patient the indication for DBT was IBD and concurrent EIMs, each one responding to different biologic, this patient was initially co-treated with IMM and steroids; dual therapy was effective and safe, with standard doses.
Conclusion
Our experience is in line with that described by other authors. DBT in clinical practice is offered to long-standing and refractory IBD. In these cases, effectiveness seems limited, with concerns on infectious adverse events, but surgery probably carries worse prospects. For the indication of IBD with EIMs not responding to the same biologic, DBT seems more effective. More data is needed to know in which cases and what combinations could be beneficial.