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Efficacy and Tolerance of a Combination of Targeted Therapies Indicated for Asthma and Chronic Inflammatory
Leo Etronnier1, Cedric Lukas1, Baptiste Gérard2
1Rheumatology center, Lapeyronie Teaching Hospital, National Reference Center for Rare Autoimmune Systemic Diseases, 34295 Montpellier, France.
Objective:
The use of combined targeted therapies is increasing in clinical practice, both within and across diseases. However, data on dual targeted therapy for patients with both chronic inflammatory rheumatism (CIR) and severe allergic asthma remain limited, especially regarding treatment outcomes and safety, including infection risk. The objective of this study was to assess the impact of this combination on the course of both chronic inflammatory diseases as well as their safety profile.
Methods:
This retrospective, observational study included patients treated with dual targeted therapies for CIR and asthma from December 2020 to June 2023. Each distinct therapeutic combination was analyzed individually. This study was carried out in collaboration with rheumatologists and pulmonologists from multiple French hospital centers.
Results:
A total of 19 therapeutic combinations were analyzed in 16 patients, including 11 with rheumatoid arthritis (68.8%) and 4 with spondyloarthritis (25%). Rheumatologic treatments included mainly anti-cytokine therapies used in 11 patients (57.9%) (7 with TNFα antagonists, 3 with anti-IL17 antibodies and 1 with tocilizumab) and 8 patients (42.1%) with another mode of action (4 with abatacept, 3 with JAK inhibitors, and 1 with rituximab). Asthma therapy involved anti-IL5 receptor biologics in 15 patients (78.9%). The mean duration of dual therapy was 14.2 ± 8.4 months. Four combinations (21.1%) required modification of the rheumatologic treatment, three cases (15.8%) due to inadequate disease control and one due to remission of CIR (5.25%). Three other combinations (15.8%) were modified due to poor asthma control, and three (15.8%) due to adverse events. Overall, 11 out of 19 combinations (57.9%) were associated with adverse events, including 7 serious events (63.6%). The most frequent were respiratory infections (5 cases).
Conclusions:
This is the largest case series to date on dual targeted therapy for CIR and allergic asthma. Rheumatologic control was generally maintained, particularly when rheumatologic treatment was initiated first. Pulmonary infections were the main adverse events, highlighting the need for caution in patients with additional pulmonary comorbidities.
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