Hospices Civils de Lyon, Université Claude Bernard Lyon1, Hôpital Lyon-Sud, Service d’hépato-gastroentérologie, Bâtiment 3A, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite
INSERM U1111 – Centre Internationalde Recherche en Infectiologie (CIRI), Lyon
Despite a wide therapeutic armamentarium in inflammatory bowel diseases, the usefulness of combotherapy (immunosuppressants and biologics) remains discussed case by case and should take into account the benefit/risk ratio. In the absence of contraindication, combotherapy should be considered with infliximab as soon as first line therapy in order to optimize efficacy and to avoid immunisation responsible for lost of response. Combotherapy should also be considered after a first immunogenic failure with anti-TNF and that whatever the anti-TNF used in second line. In case of risk factors especially in Crohn's disease (perianal or extensive lesions), adalimumab should be associated with immunossupressants. The benefit of combotherapy with other biologics (ustékinumab, védolizumab) has not yet been demonstrated. Addition of a second biologic in severe and refractory Crohn's disease or IBD associated with immune mediated inflammatory diseases uncontrolled under a first biologic could be considered after discussion in multidisciplinary meeting. The efficacy of such strategy of combining simultaneously 2 biologics remains to be fully demonstrated. Nevertheless, such strategy could be efficient in some selected IBD patients with an overal good tolerance even if an increased risk of infections should be taken into account. In this short review, we will finally report the usefulness of alternative strategy using bispecific therapeutic monoclonal antibodies in IBD.