https://doi.org/10.4081/monaldi.2024.3079
Combination treatment with monoclonal antibodies for the management of severe asthma and immune-mediated inflammatory diseases: a comprehensive review
Submitted: June 11, 2024
Accepted: September 9, 2024
Published: October 7, 2024
Accepted: September 9, 2024
Abstract Views: 580
PDF_EARLY VIEW: 155
SUPPLEMENTARY MATERIAL: 19
SUPPLEMENTARY MATERIAL: 19
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Biological drugs have revolutionized the management of severe asthma, and a tailored treatment approach made it possible to consider remission as an achievable treatment target. The incidence of autoimmune diseases is increasing in many parts of the world. Patients suffering from severe asthma, eligible or already treated with an asthma-approved biologic agent, may suffer from another immune-mediated inflammatory disease (IMID) that could require the simultaneous use of a second monoclonal antibody. The real-life studies available in the literature describing the concurrent administration of an asthma-approved biologic agent with another biologic for a different immune disease, obtained through a systematic search on online databases based on monoclonal antibodies, were collected and analyzed. 26 articles were included in this review according to the prespecified inclusion and exclusion criteria. All included papers were retrospective in nature. Study designs were case reports (n=18), case series (n=3), retrospective chart reviews (n=3), retrospective observational studies (n=1), and cohort studies (n=1). The study is intended to present, within the current literature, all the administered combinations of severe asthma-approved biologics with monoclonal antibodies for a different indication. Those were grouped according to the IMID for whom the second biologic agent, with a different mechanism of action, was prescribed. The combinations prescribed to the cohort of patients specifically treating uncontrolled severe asthma were deeper evaluated in the discussion section, since an analysis of these therapeutic combinations deriving from real-life experiences may be useful to optimize the management of patients with severe asthma, ultimately leading to improved patient care and outcomes. Prospective registries and future studies are required to assess the safety and efficacy of combination therapies for severe asthmatic patients who suffer from an IMID.
McInnes IB, Gravallese EM. Immune-mediated inflammatory disease therapeutics: past, present and future. Nat Rev Immunol 2021;21:680-6.
DOI: https://doi.org/10.1038/s41577-021-00603-1
Kuek A, Hazleman BL, Ostör AJK. Immune-mediated inflammatory diseases (IMIDs) and biologic therapy: a medical revolution. Postgrad Med J 2007;83:251-60.
DOI: https://doi.org/10.1136/pgmj.2006.052688
Brusselle GG, Koppelman GH. Biologic therapies for severe asthma. N Engl J Med 2022;386:157-71.
DOI: https://doi.org/10.1056/NEJMra2032506
Lugogo NL, Mohan A, Akuthota P, et al. Are we ready for asthma remission as a clinical outcome? Chest 2023;164:831-4.
DOI: https://doi.org/10.1016/j.chest.2023.04.028
Thomas D, McDonald VM, Pavord ID, Gibson PG. Asthma remission: what is it and how can it be achieved? Eur Respir J 2022;60:2102583.
DOI: https://doi.org/10.1183/13993003.02583-2021
Miller FW. The increasing prevalence of autoimmunity and autoimmune diseases: an urgent call to action for improved understanding, diagnosis, treatment and prevention. Curr Opin Immunol 2023;80:102266.
DOI: https://doi.org/10.1016/j.coi.2022.102266
Sharma C, Bayry J. High risk of autoimmune diseases after COVID-19. Nat Rev Rheumatol 2023;19:399-400.
DOI: https://doi.org/10.1038/s41584-023-00964-y
Cao F, Liu YC, Ni QY, et al. Temporal trends in the prevalence of autoimmune diseases from 1990 to 2019. Autoimmun Rev 2023;22:103359.
DOI: https://doi.org/10.1016/j.autrev.2023.103359
Carriera L, Fantò M, Martini A, et al. Combination of biological therapy in severe asthma: where we are? J Pers Med 2023;13:1594.
DOI: https://doi.org/10.3390/jpm13111594
Gisondi P, Maurelli M, Costanzo A, et al. the combination of dupilumab with other monoclonal antibodies. Dermatol Ther 2022;13:7-12.
DOI: https://doi.org/10.1007/s13555-022-00851-6
Koç Yıldırım S, Erbağcı E, Hapa A. Omalizumab treatment in combination with any other biologics: Is it really a safe duo? Australas J Dermatol 2023;64:229-33.
DOI: https://doi.org/10.1111/ajd.14019
Fougerousse AC, Becherel PA, Pallure V, et al. Combining omalizumab with another biotherapy. Acta Derm Venereol 2019;99:448-9.
DOI: https://doi.org/10.2340/00015555-3140
Barry K, Zancanaro P, Casseres R, et al. A retrospective review of dupilumab and psoriasis biologic combination therapy. J Dermatolog Treat 2021;32:438-9.
DOI: https://doi.org/10.1080/09546634.2019.1659481
Lommatzsch M, Suhling H, Korn S, et al. Safety of combining biologics in severe asthma: asthma-related and unrelated combinations. Allergy 2022;77:2839-43.
DOI: https://doi.org/10.1111/all.15379
Gerger V, Rummenigge C, Pinter A, Kaufmann R. Safety and efficacy of blocking IL-4/13 and IL-23 in concomitant atopic dermatitis and psoriasis - two case reports. J Dtsch Dermatol Ges 2023;21:648-50.
DOI: https://doi.org/10.1111/ddg.15015
Diluvio L, Vollono L, Zangrilli A, et al. Omalizumab and adalimumab: a winning couple. Immunotherapy 2020;12:1287-92.
DOI: https://doi.org/10.2217/imt-2020-0203
Karstarli Bakay OS, Kacar N. Combined treatment with omalizumab and secukinumab in a patient with chronic spontaneous urticaria and psoriasis. Dermatol Ther 2022;35:e15638.
DOI: https://doi.org/10.1111/dth.15638
Kabbani M, Mboyo Mpita G, Benhadou F. Ustekinumab plus dupilumab in the treatment of concomitant psoriasis and prurigo nodularis. J Eur Acad Dermatol Venereol 2022;36:e1050-1.
DOI: https://doi.org/10.1111/jdv.18445
Balestri R, Magnano M, Girardelli CR, et al. Long-term safety of combined biological therapy in a patient affected by arthropathic psoriasis and atopic dermatitis. Dermatol Ther 2020;33:e13498.
DOI: https://doi.org/10.1111/dth.13498
Mahar PD, Zubrinich CM, Manuelpillai N, Foley P. Combination treatment with monoclonal antibodies: Secukinumab, benralizumab and dupilumab for the combined management of psoriasis and severe asthma. Australas J Dermatol 2021;62:506-8.
DOI: https://doi.org/10.1111/ajd.13676
Diluvio L, Pensa C, Piccolo A, et al. Coesisting inflammatory skin diseases: Tildrakizumab to control psoriasis and omalizumab for urticaria. Dermatol Ther 2022;35:e15359.
DOI: https://doi.org/10.1111/dth.15359
Benko M, Hrvatin Stancic B, Lunder T. Two track biologic therapy for concurrent chronic spontaneous urticaria and psoriasis vulgaris in one patient. Actas Dermosifiliogr 2022;113:995-6.
DOI: https://doi.org/10.1016/j.ad.2021.02.029
Abdelmaksoud A, Temiz SA, Daye M, et al. Response of chronic refractory psoriasis vulgaris with urticaria to combined secukinumab and omalizumab: a case report and review of the literature. J Cosmet Dermatol 2023;22:1416-8.
DOI: https://doi.org/10.1111/jocd.15551
Kaszycki MA, Pixley JN, Feldman SR. Concurrent atopic dermatitis and psoriasis successfully treated with dual biologic therapy. Cutis 2023;112:E13-6.
DOI: https://doi.org/10.12788/cutis.0858
Spencer EA, Dolinger MT, Dubinsky MC. A single-center experience with dupilumab for atopic or psoriasiform dermatitis in patients with inflammatory bowel disease. Dig Dis Sci 2023;68:1121-4.
DOI: https://doi.org/10.1007/s10620-022-07684-5
Malik M, Jones B, Williams E, et al. Dual biologic therapy for the treatment of rheumatic diseases and asthma: a case series. Rheumatol Adv Pract 2023;7:rkad018.
DOI: https://doi.org/10.1093/rap/rkad018
Alegre-Bailo A, Sánchez-Gilo A, Gonzalo González I, Vicente Martín FJ. Combination treatment with monoclonal antibodies: dupilumab and ustekinumab for the treatment of severe atopic dermatitis and Crohn disease. Australas J Dermatol 2024;65:63-6.
DOI: https://doi.org/10.1111/ajd.14185
Patel B, Butterfield JH, Weiler CR, Kane SV. Tolerance and efficacy with simultaneous use of two monoclonal antibodies for a patient with hypereosinophilic syndrome and ulcerative colitis. Monoclon Antib Immunodiagn Immunother 2016;35:300-3.
DOI: https://doi.org/10.1089/mab.2016.0038
Takeuchi N, Yamanishi A, Kumagai Y, Yokoyama T. Successful combined treatment with omalizumab and tocilizumab in a case of chronic spontaneous urticaria and rheumatoid arthritis: a case report and literature review. Trends Immunother 2022;6:1-3.
DOI: https://doi.org/10.24294/ti.v6.i2.1443
Yamada H, Hida N, Kurashima Y, et al. A case of severe eosinophilic asthma and refractory rheumatoid arthritis well controlled by combination of IL-5Rα antibody and TNFα inhibitor. Allergol Int 2019;68:536-8.
DOI: https://doi.org/10.1016/j.alit.2019.04.003
Ghazanfar MN, Thomsen SF. Combined treatment with omalizumab and etanercept in a patient with chronic spontaneous urticaria and rheumatoid arthritis. J Dermatolog Treat 2019;30:387-8.
DOI: https://doi.org/10.1080/09546634.2018.1515465
Steinhoff M, Al-Marri F, Al Chalabi R, et al. Recalcitrant erythrodermic ichthyosis with atopic dermatitis successfully treated with dupilumab in combination with Guselkumab. Skin Health Dis 2022;2:e87.
DOI: https://doi.org/10.1002/ski2.87
Le ST, Herbert S, Haughton R, et al. Rituximab and omalizumab combination therapy for bullous pemphigoid. JAMA Dermatol 2024;160:107-9.
DOI: https://doi.org/10.1001/jamadermatol.2023.4508
Kwon IJ, Kim T, Yoo DS, et al. Clinical effect of omalizumab as an adjuvant treatment to rituximab in patient with refractory bullous pemphigoid. J Dermatol 2023;50:705-9.
DOI: https://doi.org/10.1111/1346-8138.16678
Afiari A, Gabriel A, Gaiki MR. Concurrent use of mepolizumab and rituximab for eosinophilic granulomatosis with polyangiitis and multisystem involvement. Cureus 12:e9242.
Mutoh T, Shirai T, Sato H, et al. Multi-targeted therapy for refractory eosinophilic granulomatosis with polyangiitis characterized by intracerebral hemorrhage and cardiomyopathy: a case-based review. Rheumatol Int 2022;42:2069-76.
DOI: https://doi.org/10.1007/s00296-021-04950-z
Kuruvilla ME, Lee FEH, Lee GB. Understanding asthma phenotypes, endotypes, and mechanisms of disease. Clin Rev Allergy Immunol 2019;56:219-33.
DOI: https://doi.org/10.1007/s12016-018-8712-1
Pelaia C, Crimi C, Vatrella A, et al. Molecular targets for biological therapies of severe asthma. Front Immunol 2020;11:603312.
DOI: https://doi.org/10.3389/fimmu.2020.603312
Peri F, Amaddeo A, Badina L, et al. T2-low asthma: a discussed but still orphan disease. Biomedicines 2023;11:1226.
DOI: https://doi.org/10.3390/biomedicines11041226
Menzies-Gow A, Corren J, Bourdin A, et al. Tezepelumab in adults and adolescents with severe, uncontrolled asthma. N Engl J Med 2021;384:1800-9.
DOI: https://doi.org/10.1056/NEJMoa2034975
Jang D in, Lee AH, Shin HY, et al. The role of tumor necrosis factor alpha (TNF-α) in autoimmune disease and current TNF-α inhibitors in therapeutics. Int J Mol Sci 2021;22:2719.
DOI: https://doi.org/10.3390/ijms22052719
Doss GPC, Agoramoorthy G, Chakraborty C. TNF/TNFR: drug target for autoimmune diseases and immune-mediated inflammatory diseases. Front Biosci 2014;19:1028-40.
DOI: https://doi.org/10.2741/4265
Adegbola SO, Sahnan K, Warusavitarne J, Hart A, Tozer P. Anti-TNF therapy in Crohn’s disease. Int J Mol Sci 2018;19:2244.
DOI: https://doi.org/10.3390/ijms19082244
Sands BE, Kaplan GG. The role of TNFalpha in ulcerative colitis. J Clin Pharmacol 2007;47:930-41.
DOI: https://doi.org/10.1177/0091270007301623
Choy EH, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med 2001;344:907-16.
DOI: https://doi.org/10.1056/NEJM200103223441207
Ogawa E, Sato Y, Minagawa A, Okuyama R. Pathogenesis of psoriasis and development of treatment. J Dermatol 2018;45:264-72.
DOI: https://doi.org/10.1111/1346-8138.14139
Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci 2019;20:1475.
DOI: https://doi.org/10.3390/ijms20061475
Kuenzig ME, Bishay K, Leigh R, et al. Co-occurrence of asthma and the inflammatory bowel diseases: a systematic review and meta-analysis. Clin Transl Gastroenterol 2018;9:188.
DOI: https://doi.org/10.1038/s41424-018-0054-z
Kim JG, Kang J, Lee JH, Koo HK. Association of rheumatoid arthritis with bronchial asthma and asthma-related comorbidities: a population-based national surveillance study. Front Med 2023;10:1006290.
DOI: https://doi.org/10.3389/fmed.2023.1006290
Shen TC, Lin CL, Wei CC, et al. The risk of asthma in rheumatoid arthritis: a population-based cohort study. QJM 2014;107:435-42.
DOI: https://doi.org/10.1093/qjmed/hcu008
Klareskog L, Catrina AI. Autoimmunity: lungs and citrullination. Nat Rev Rheumatol 2015;11:261-2.
DOI: https://doi.org/10.1038/nrrheum.2015.38
Kankaanranta H, Ilmarinen P, Zhang X, et al. Tumour necrosis factor-α regulates human eosinophil apoptosis via ligation of TNF-receptor 1 and balance between NF-κB and AP-1. PLoS One 2014;9:e90298.
DOI: https://doi.org/10.1371/journal.pone.0090298
Loktionov A. Eosinophils in the gastrointestinal tract and their role in the pathogenesis of major colorectal disorders. World J Gastroenterol 2019;25:3503-26.
DOI: https://doi.org/10.3748/wjg.v25.i27.3503
Hällgren R, Feltelius N, Svenson K, Venge P. Eosinophil involvement in rheumatoid arthritis as reflected by elevated serum levels of eosinophil cationic protein. Clin Exp Immunol 1985;59:539-46.
Guellec D, Milin M, Cornec D, et al. Eosinophilia predicts poor clinical outcomes in recent-onset arthritis: results from the ESPOIR cohort. RMD Open 2015;1:e000070.
DOI: https://doi.org/10.1136/rmdopen-2015-000070
Belmesk L, Muntyanu A, Cantin E, et al. Prominent role of type 2 immunity in skin diseases: beyond atopic dermatitis. J Cutan Med Surg 2022;26:33-49.
DOI: https://doi.org/10.1177/12034754211027858
Amin M, No DJ, Egeberg A, Wu JJ. Choosing first-line biologic treatment for moderate-to-severe psoriasis: what does the evidence say? Am J Clin Dermatol 2018;19:1-13.
DOI: https://doi.org/10.1007/s40257-017-0328-3
Lotti T, Hercogova J, Prignano F. The concept of psoriatic disease: can cutaneous psoriasis any longer be separated by the systemic comorbidities? Dermatol Ther 2010;23:119-22.
DOI: https://doi.org/10.1111/j.1529-8019.2010.01305.x
Bourdin A, Halimi L, Vachier I, et al. Adherence in severe asthma. Clin Exp Allergy 2012;42:1566-74.
DOI: https://doi.org/10.1111/j.1365-2222.2012.04018.x
Crimi C, Calabrese C, D’Amato M, et al. Patient and physician perspectives on biological treatment in severe asthma: a Severe Asthma Network Italy survey. ERJ Open Res 2023;9:00560-2023.
DOI: https://doi.org/10.1183/23120541.00560-2023
Menzies-Gow AN, Price DB. Clinical remission in severe asthma: how to move from theory to practice. Chest 2023;164:296-8.
DOI: https://doi.org/10.1016/j.chest.2023.03.001
Hansen S, Baastrup Søndergaard M, von Bülow A, et al. Clinical response and remission in patients with severe asthma treated with biologic therapies. Chest 2024;165:253-66.
DOI: https://doi.org/10.1016/j.chest.2023.10.046
How to Cite
Carriera, Lorenzo, Sara Caporuscio, Marta Fantò, Alice D’Abramo, Genesio Puzio, Luca Triolo, and Angelo Coppola. 2024. “Combination Treatment With Monoclonal Antibodies for the Management of Severe Asthma and Immune-Mediated Inflammatory Diseases: A Comprehensive Review”. Monaldi Archives for Chest Disease, October. https://doi.org/10.4081/monaldi.2024.3079.
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Massimiliano Polastri, Lara Pisani, Andrea Dell'Amore, Stefano Nava, Revolving door respiratory patients: A rehabilitative perspective , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- I. Blanco, H. Canto, J. Flóres, C. Camblor, V. Cárcaba, F.J. de Serres, S. Janciauskiene, E.F. Bustillo, Long-term augmentation therapy with Alpha-1 Antitrypsin in an MZ-AAT severe persistent asthma , Monaldi Archives for Chest Disease: Vol. 69 No. 4 (2008): Pulmonary series
- Carlos A. Jiménez-Ruiz, Marcos Garcia Rueda, Manuel A. Martinez Muñiz, Jacobo Sellarés, Maria A. Jiménez-Fuentes, Lourdes Lázaro Asegurado, Esther RodrÃguez Gonzalez, Concepción Rodriguez Garcia, Oriol Armengol, Emilia Abad, Teresa Peña, Adolfo Domenech del Rio, Juan A. Riesco Miranda, Varenicline in smokers with severe or very severe COPD after 24 weeks of treatment. A descriptive analysis: VALUE study , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Elio Gorga, Marta Scodro, Francesca Valentini, Renzo D'Ortona, Mariachiara Arisi, Edoardo Sciatti, Ivano Bonadei, Valentina Regazzoni, Enrico Vizzardi, Marco Metra, Piergiacomo Calzavara Pinton, Echocardiographic evaluation of diastolic dysfunction in young and healthy patients with psoriasis: A case-control study , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- F. Novelli, F. Costa, M. Latorre, L. Malagrinò, A. Celi, B. Vagaggini, P. Paggiaro, Tiotropium: a new therapeutic option in asthma , Monaldi Archives for Chest Disease: Vol. 79 No. 3-4 (2013): Pulmonary series
- C. Incorvaia, C. Pravettoni, M. Mauro, M.-R. Yacoub, F. Tarantini, G.G. Riario-Sforza, Effectiveness of omalizumab in a patient with severe asthma and atopic dermatitis , Monaldi Archives for Chest Disease: Vol. 69 No. 2 (2008): Pulmonary series
- Vishal Chopra, Hardik Jain, Akhil D. Goel, Siddharth Chopra, Ashrafjit S. Chahal, Neha Garg, Vidhu Mittal, Correlation of aspergillus skin hypersensitivity with the duration and severity of asthma , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Claudio F. Donner, Sandro Amaducci, Elena Bacci, Sandra Baldacci, Maria L. Bartoli, Gianfranco M. Beghi, Alida Benfante, Sara Brighindi, Lucio Casali, Daniela Castiglia, Mario Cazzola, Alessandro Celi, Silvana Cianchetti, Giorgio Colombo, Claudia Crimi, Federico L. Dente, Giuseppe Di Maria, Annalisa Di Maria, Manuela Latorre, Federico Lavorini, Sara Maio, Claudia Mannini, Riccardo Messina, Pier Luigi Paggiaro, Patrizia Pignatti, David Price, Nicola Scichilone, Marzia Simoni, Antonio Spanevello, Martina Stagno d’Alcontres, Shawna Tan, Roberto Torchio, Giovanni Viegi, Dina Visca, Emiel F.M. Wouters, Shaylynn Yu Hui Xin, Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- G. Caramori, M. Fabbri, D. Paioli, F. Falcone, C. Severino, G. Felisatti, O. Arar, I.M. Adcock, K. Fan Chung, P.J. Barnes, A. Ciaccia, A. Papi, Asthma is not a common cause of severe chronic respiratory failure in non-smokers: ALOT study , Monaldi Archives for Chest Disease: Vol. 63 No. 2 (2005): Pulmonary series
- F.M. De Benedictis, I. Carloni, A. Bush, The dark side of the moon: severe therapy-resistant asthma in children , Monaldi Archives for Chest Disease: Vol. 77 No. 2 (2012): Pulmonary series
You may also start an advanced similarity search for this article.
