, the senior scientific director of the gastrointestinal contract research firm Alimentiv in London, Ontario, Canada, told Medscape. People were reluctant to try new biologic combinations, owing to the fear that these safety issues would plague subsequent trials.But a recent phase 2 trial, led by Feagan, suggests that certain combinations can be effective.
While these combinations require controlled clinical trials,"there's some smoke signals out there that this might be an effective strategy for some patients," Ritchlin said.is evaluating the combination of baricitinib , a Janus kinase inhibitor, and adalimumab. Although baricitinib is not a biologic, as a targeted synthetic DMARD, the therapy is more potent than conventional DMARDs, and the same potential safety concerns apply.
"Although abatacept has shown a very good tolerance profile that might be superior to other bDMARDs [biologic DMARDs], rheumatologists might be reluctant to use it as a first line bDMARD as there is a belief of a slower efficacy compared to other bDMARDs or JAK inhibitors," according to the clinical trial's description.
Insurance coverage remains a"huge challenge" for these dual therapies because of the higher expense, noted Ritchlin. Better targeting therapies could help convince these companies to pay for these therapies.
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