Concurrent Dual Biologic Therapy (Infliximab-Risankizumab and Dupilumab-Rituximab) for Complex Treatment-Refractory...

The use of targeted biologic therapies has transformed the management of inflammatory dermatoses. However, treatment becomes increasingly complex when patients require simultaneous immunomodulation for coexisting systemic conditions. Evidence guiding the concurrent use of dual biologic therapies remains limited.

We report two cases illustrating the use of concurrent dual biologic therapy in treatment-refractory dermatologic disease. The first case involves a woman with ulcerative colitis who developed paradoxical psoriasis while receiving infliximab. Discontinuation of infliximab resulted in a gastrointestinal disease flare, necessitating continuation of therapy. Concomitant treatment with risankizumab led to marked improvement in cutaneous disease without adverse effects. The second case describes a woman with severe, treatment-resistant atopic dermatitis receiving maintenance rituximab for indolent non-Hodgkin lymphoma. Dupilumab was initiated following interdisciplinary consultation, resulting in sustained dermatologic remission over long-term follow-up with no treatment-emergent adverse events.

These cases highlight the potential role of carefully selected concurrent dual biologic therapy in managing complex, treatment-refractory dermatologic disease when monotherapy is insufficient and discontinuation of essential systemic treatment is not feasible. Multidisciplinary collaboration and close monitoring are essential when considering such therapeutic strategies.