Combination biologics or targeted synthetic disease-modifying anti-rheumatic drugs in the treatment of spondyloarthritis: a systematic literature review

Expert Rev Clin Immunol. 2024 Jul;20(7):735-743. doi: 10.1080/1744666X.2024.2327589. Epub 2024 Mar 27.

Abstract

Introduction: The advent of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) have transformed the management of immune-mediated rheumatic diseases, including spondylarthritis (SpA). However, the data about combining b/ts DMARDs in the treatment of SpA are scarce. The study objectives were to assess the efficacy and safety of combination b/tsDMARD in SpA.

Methods: We conducted systematic literature review (PubMed and Medline) with two independent reviewers, one adjudicator, exploring the efficacy and safety of combination b/tsDMARDs in the treatment of SpA. Inclusion criteria were studies published in last 20 years, English language, interventions included use of two b/tsDMARDs, and minimal three-month follow-up.

Results: Out of 1936 initial hits, 28 manuscripts fulfilled the inclusion criteria. Two were randomized controlled trials, and the remaining were retrospective cohort studies or case series. Combination of apremilast with bDMARD, or TNF inhibitor plus IL12/23 inhibitor were the commonest and reported good efficacy with no increased safety signal.

Conclusions: There is not enough data to fully evaluate efficacy and safety of combination b/tsDMARDs in SpA treatment. Limited information shows apremilast plus bDMARD, or TNF inhibitor plus IL12/23 inhibitor combination to be efficacious and safe. Randomized controlled trials and larger cohort with a longer follow-up are required.

Keywords: IL-17 inhibitors; IL-23 inhibitors; JAK inhibitors; PDE4 inhibitor; Spondyloarthritis; TNF inhibitors; combination biologics; targeted synthetic DMARDs.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Antirheumatic Agents* / therapeutic use
  • Biological Products* / therapeutic use
  • Drug Therapy, Combination*
  • Humans
  • Randomized Controlled Trials as Topic
  • Spondylarthritis* / drug therapy
  • Thalidomide / analogs & derivatives
  • Thalidomide / therapeutic use
  • Treatment Outcome

Substances

  • Antirheumatic Agents
  • Biological Products
  • Thalidomide
  • apremilast