Year 2026 / Volume 118 / Number 3
Original
Effectiveness and safety of dual advanced therapy in inflammatory bowel disease: a multicenter series from Galicia, Spain

131-138

DOI: 10.17235/reed.2025.11430/2025

M.ª Teresa Diz-Lois Palomares, Carmen Pradera Cibreiro, Carmen Cabezal Iglesias, Manuel Barreiro de Acosta, Jesús Martínez Cadilla, Emilio Estévez Prieto, Rocío Ferreiro-Iglesias, Daniel Carpio López, Ana Echarri Piudo,

Abstract
Background: approximately one-third of patients with inflammatory bowel disease (IBD) do not achieve disease control despite the incorporation of new advanced therapies in recent years. The combination of two advanced therapies (AT) can overcome this therapeutic ceiling; therefore, these therapies have been empirically tested in real-life clinical practice, but evidence is lacking on how and when to combine them. Methods: a multicenter retrospective study was designed, reviewing cases treated with dual advanced therapy (DAT). We examine its characteristics, effectiveness and adverse effects, and explore potential variables associated with its effectiveness. Results: a total of 29 DAT regimens were documented in 24 patients, with a median duration of seven months (IQR 0.5-43 months). Overall clinical remission was 41.1 % (36 % when DAT was indicated for refractory IBD, and 60 % when indicated for immune-mediated inflammatory diseases (IMID) and IBD. Endoscopic/radiological response was observed in 31.6 % of the evaluated patients (n = 19). In 17 cases (58.6 %), DAT was discontinued, three of them due to deep remission. The median survival without discontinuation due to inefficacy or adverse events was 20 months. No differences in effectiveness were observed based on the combined mechanisms of action, or on the strategy of adding new versus recycled AT. Conclusions: empirical use of DAT in refractory IBD may lead to clinical remission in approximately one-third of patients. Remission rates appeared more effective when DAT was used to simultaneously treat IBD and an IMID. However, further data are needed before specific recommendations can be made regarding type or timing strategy for DAT.
Lay Summary
Inflammatory bowel disease (IBD) is a chronic condition that primarily affects young individuals and significantly impairs quality of life. Despite the emergence of new treatments, adequate disease control is not achieved in more than one-third of patients. Consequently, with the progressive introduction of new therapies, empirical combinations of these agents have been increasingly used in an attempt to overcome the therapeutic ceiling in refractory patients. However, evidence regarding the benefit of these combinations and which specific regimens may be effective remains limited. We reviewed the data from the IBD units of the hospitals within our Autonomous Community to assess the outcomes of these combination therapies. We found that approximately 40 % of patients achieved clinical benefit, while one-third of patients showed improvement in mucosal inflammation as assessed by endoscopy and/or radiological imaging. When the combination was indicated for both IBD and another immune-mediated inflammatory disease (IMID), the efficacy appeared to be higher, with clinical remission achieved in 60 % of cases. We did not identify treatment- or patient-related factors associated with greater efficacy, likely due to the sample size limitation and case heterogeneity.
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Diz-Lois Palomares M, Pradera Cibreiro C, Cabezal Iglesias C, Barreiro de Acosta M, Martínez Cadilla J, Estévez Prieto E, et all. Effectiveness and safety of dual advanced therapy in inflammatory bowel disease: a multicenter series from Galicia, Spain. 11430/2025


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Publication history

Received: 23/06/2025

Accepted: 11/08/2025

Online First: 29/09/2025

Published: 06/03/2026

Article Online First time: 98 days

Article editing time: 256 days


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