Dual biological treatments in immune-mediated disorders: a single center experience

Background: Physicians may encounter situations where they need to co-administer omalizumab with non–IgE-targeting monoclonal antibodies. In this study, we share our experience with these dual biologic treatments. Objective: To evaluate the efficacy and safety of dual biological therapy using omalizumab and non-IgE-targeting monoclonal antibodies at a single center. Methods: We retrospectively reviewed the medical records of adults treated with a dual biological therapy regimen consisting of omalizumab and another biologic between 2020 and 2022. Results: Our review identified nine patients (age range: 51–75 years, 7 women and 2 men) who were treated with omalizumab for high Th2 disorders, including chronic spontaneous urticaria (n = 7) and asthma (n = 2). Seven patients received a second biologic for co-existing non-Th2 disorders, while two received an additional biologic to better control their Th2-mediated disorders. The patients were treated with the following biologics: anti-IL-5 agents (mepolizumab [n = 1] and benralizumab [n = 1]), the IL-4/13 inhibitor dupilumab (n = 1), the anti-IL-17 biologic secukinumab (n = 1), the IL-1 inhibitor anakinra (n = 1), the anti-calcitonin gene–related peptide agent fremanezumab (n = 1), and anti-TNF-α agents (etanercept [n = 1], golimumab [n = 1], and adalimumab [n = 1]). Dual biotherapy was administered for 3–34 months with observed clinical improvement. No adverse events or infections were reported. Conclusions: Dual biological treatment with omalizumab and another biologic appears to be safe, with no need to discontinue non–IgE-targeting agents during omalizumab therapy.