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Effectiveness and safety of combined biological therapy in patients with refractory multidomain spondyloarthritis
  1. Cristina Valero1,
  2. Juan Pablo Baldivieso1,
  3. Isidoro Gonzalez-Alvaro1,
  4. Eva Tomero1,
  5. Santos Castañeda1,2,
  6. Rosario García-Vicuña1,3
  1. 1 Rheumatology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
  2. 2 Department of Medicine. Cátedra UAM-ROCHE, EPID-Future, Universidad Autonoma de Madrid, Madrid, Spain
  3. 3 Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
  1. Correspondence to Dr Rosario García-Vicuña, Rheumatology, Hospital Universitario de la Princesa, Madrid, Spain; mariadelrosario.garcia{at}

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Combined biological therapy (CBT) is discouraged in the treatment guidelines of immune-mediated diseases due to lack of consistent evidence. The blockade of two inflammatory pathways together could increase the overall risk of infections or unexpected adverse events (AEs). Nevertheless, several reports have shown beneficial results of CBT in refractory patients with inflammatory bowel disease (IBD), with a low rate of serious AE.1 2 Combination treatments most used include an anti-tumour necrosis factor (TNF) or anti-IL12/23 receptor (anti-IL12/23R) antibody plus an anti-α4/β7-integrin agent.

In psoriatic arthritis (PsA), previous case series have shown favourable efficacy results with CBT, mainly with an anti-TNF agent in combination with an anti-IL12/23R,3 4 but some patients presented AE.3 4 The experience with CBT in spondyloarthritis (SpA) is limited, usually in patients with concomitant IBD.1 2 The aim of this work was to determine the effectiveness and safety of CBT in patients with SpA.

We present a retrospective case series, which identified nine patients with SpA under CBT, from April 2017 to October 2021, with a minimum 3-month exposure to two simultaneous biologics with different therapeutic targets (table 1). All patients fulfilled criteria for axial or peripheral …

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  • Handling editor Josef S Smolen

  • Twitter @cristinavalero6

  • Contributors Conception or design of the work: RG-V. Acquisition of data: CV. Analysis and interpretation of data: all authors. Drafting of the manuscript CV, SC and RG-V. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: CV. Review and approval of the final version of the manuscript: all authors. Supervision: SC and RG-V.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Cristina Valero, Juan Pablo Baldivieso Achá, Eva Tomero, Isidoro González Álvaro, Santos Castañeda and Rosario Garcia de Vicuña declare that they have no conflict of interest related to the work submitted for publication. RGV reported receiving research or educational grants support from Abbvie, Janssen, Novartis, Pfizer and Sandoz, honoraria for presentations (Pfizer, Sandoz) or advisory boards (Abbvie, Biogen, MSD, Pfizer) and nonfinancial support from Abbvie, MSD, Novartis, Pfizer and UCB; all outside the present work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.