AB0948 TWO TREATMENTS AND ONE DESTINATION: ANALYSIS OF A SERIES OF CASES WITH DUAL-TARGETED THERAPY IN A THIRD LEVEL HOSPITAL
Authors: I. González, I. González Fernández, C. Álvarez Castro, I. Latras Cortés, E. Diez Álvarez
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Dual-targeted therapy<sup>1</sup> has become a possible tool to treat patients with spondyloarthritis (SpA), especially, those refractory to several treatments and/or with active concomitant domains, inflammatory bowel disease (IBD) and psoriasis, despite usual medication. Currently, the available evidence on possible treatment combinations and their profile of safety/efficacy are limited. <h3>Objectives:</h3> To describe clinical-epidemiological characteristics of patients with SpA who have required dual-targeted therapy and the complications derived from the combined use of biological disease-modifying drugs (bDMARDs) and JAK inhibitors (JAKi). <h3>Methods:</h3> We performed a descriptive observational study of patients diagnosed with SpA (ASAS, CASPAR and NEW YORK criteria) in our center who received dual-targeted therapy until December 31, 2023. The following variables are described: diagnosis, sex, average age at diagnosis and at the start of treatment, analytical parameters (C-Reactive protein CRP/fecal Calprotectin/HLA-B27), cardiovascular risk factors (CVRF) and toxic habits; infectious/thrombotic/neoplastic events due to dual targeted therapy and remission of the disease at last consultation. <h3>Results:</h3> Five patients were included, 3 men/2 women, the mean age at diagnosis of SpA of 41.08±13.3 years; HLA-B27 was negative in all patients. Four had a diagnosis of IBD-associated SpA (IBD-SpA) and 1 of psoriatic arthritis (PsA). Two patients had axial involvement, the intestinal involvement was predominantly in the small intestine and the skin involvement was inverted psoriasis. All had CVRF (Overweight in 4, high blood pressure in 2 and smoking in 2 of them). 1 patient had a diagnosis of secondary antiphospholipid syndrome (confirmed positive lupus anticoagulant and history of pulmonary thromboembolism) and 1 had suffered an ischemic stroke that was related to smoking. 2 associated depressive syndrome. No patient had previous herpes zoster (HZ) infections, serious infections that would have required hospitalization and/or baseline neoplastic complications. In 4 of the 5 cases, the prescribed treatments were JAKi with other bDMARD due to activity at the intestinal and joint domains. The mean age at the start of combination therapy was 56±8.3 years. Two patients associated treatment with Methotrexate. None of the patients have discontinued the combination. No increase in infectious complications (HZ or others requiring hospitalization), oncological complications or analytical alterations (in the form of cytopenias) was observed during the time they were treated with the combination. A reduction in fecal Calprotectin/CRP levels and clinical improvement in joint, intestinal and skin disease were documented. <h3>Conclusion:</h3> In our experience, dual targeted therapy shows clinical improvement in the different domains of the disease with an adequate safety profile without relevant complications. Studies with a larger sample size are needed to clearly establish which drugs are the most suitable to combine as well as to identify the efficacy and safety profile. <h3>REFERENCES:</h3> [1] Valero-Martinez, C et al. <i>Dual targeted therapy in patients with psoriatic arthritis and spondyloarthritis: a real-world multicenter experience from Spain.</i> Front Immunol. 2023 Oct 23:14:1283251. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>