Biologic therapies have significantly improved outcomes in immune-mediated diseases like rheumatoid arthritis (RA) and psoriatic arthritis (PsA), yet some patients remain refractory to standard treatments. Dual biologic therapy, targeting different inflammatory pathways, has emerged as a potential strategy for these difficult-to-treat cases. Early clinical trials in RA combining TNF inhibitors with IL-1 or IL-17 inhibitors showed limited added benefit and raised safety concerns, particularly increased infection risks. More recent studies involving rituximab combinations and dual-target agents like ABT-122 and bimekizumab have shown improved safety and potential efficacy, though evidence remains mixed. Further research is needed to define the optimal combinations and patient populations.

Beyond refractory disease, dual biologic therapy is also being explored for managing comorbidities such as osteoporosis, asthma, and atopic dermatitis. Data from retrospective studies suggest that combining denosumab with bDMARDs in RA is generally safe. In PsA, case reports highlight successful outcomes using various dual biologic combinations, though adverse events have been reported. While early results are promising, dual biologic therapy remains investigational and should be approached cautiously. Larger clinical trials are needed to confirm safety, guide treatment protocols, and determine the most effective applications in complex immune-mediated disease management.

Reference: Furer V, Elkayam O. Dual Biologic Therapy in Patients with Rheumatoid Arthritis and Psoriatic Arthritis. Rambam Maimonides Med J. 2023 Apr 30;14(2):e0007. doi: 10.5041/RMMJ.10494. PMID: 37116059; PMCID: PMC10147400.