Efficacy and safety of dual therapy - biological and small molecules in patients with ulcerative colitis

Сombination of two or more biological or immunosuppressive drugs in order to achieve a synergistic effect in patients with refractory inflammatory bowel disease (IBD) has been in the spotlight for many years. Combination therapy may include various medications, most often biological and immunosuppressants. Despite the fact that biological therapy of IBD has traditionally focused on drugs that block tumor necrosis factor-alpha, the development of new drugs that act on different targets, such as vedolizumab, ustekinumab, tofacitinib or ozanimod, has made it possible to use combined immunosuppressive therapy. The treatment algorithm suggests various combinations of dual biological therapy for 2 categories of patients with IBD: patients with well-controlled luminal IBD and uncontrolled extra-intestinal symptoms (indications such as arthritis or psoriasis) and patients with refractory, uncontrolled IBD. Thus, data on the efficacy and safety of dual biological therapy as a method of treating Crohn’s disease (CD) or ulcerative colitis (UC) remain very limited. In fact, the vast majority of literature consists of individual cases and a series of cases. Given the lack of studies with a high level of evidence, gastroenterologists have turned to larger studies of dual biological therapy in other areas of medicine, such as rheumatology and dermatology. The aim of this article is to demonstrate clinical experience of combination therapy with genetically engineered biological drugs and selective immunosuppressors in UC, to analyze potential adverse effects or risks associated with combination therapy, and to determine future directions in the use of this treatment.