{
  "abstract": "Introduction Biological therapies, or monoclonal antibodies (MAbs) are increasingly used across a range of medical conditions, including severe asthma (SA). SA patients often have multiple co-morbidities, and it is increasingly common to see patients eligible for multiple MAbs for different diseases. At present, the risks of combining SA MAbs with those for other indications is unknown, with minimal evidence to support co-prescribing. We describe our experience of prescribing benralizumab alongside non-SA MAbs at a tertiary centre.Methods We conducted a retrospective review of patients on SA Mab therapy alongside at least one other MAb, identifying patients through electronic prescribing records. We assessed duration of time on dual MAbs, adverse events (AEs), deterioration of disease control, and evidence of cross-team discussions.Results We identified nine patients receiving a SA MAb alongside a non-SA MAb: four for osteoporosis, two for ankylosing spondylitis, and one each for rheumatoid arthritis, psoriasis, and inflammatory bowel disease (IBD). See table 1. Average time on dual MAb therapy was 25 months, and six patients (66%) remained on dual MAbs at time of writing.One patient reported persistent flu-type symptoms, which is a documented adalimumab-related AE, and resolved on cessation of adalimumab. Eight patients retained good asthma control whilst receiving dual Mab therapy, with one patient stopping mepolizumab at 12 months due to poor asthma response. Only one patient had cross-directorate communication prior to commencement of dual MAbs.Abstract M30 Table 1Table of dual Mab combinations SA MAb Co-prescribed MAb Indication Duration on dual therapy (months) AEs Asthma control maintained? Cross-directorate discussion Benralizumab Denosumab Osteoporosis 12 Nil Yes No Benralizumab Denosumab Osteoporosis 24 Nil Yes No Benralizumab Denosumab Osteoporosis 45 Nil Yes No Benralizumab Denosumab Osteoporosis 44 Nil Yes No 5 Benralizumab Adalimumab Rheumatoid Arthritis 24 Nil Yes No Benralizumab Adalimumab Ankylosing Spondylitis 5 Flu-like symptoms Yes No Benralizumab Bimekizumab Ankylosing spondylitis 11 Nil Yes No Mepolizumab Secukinumab Psoriasis 12 Nil No – SA MAb stopped at 12 months No Benralizumab Vedolizumab IBD 49 Nil Yes Yes Conclusion Dual MAb prescribing can be safe, with no reported AEs thought to be attributed to combined biological therapy in our cohort – specifically there were no reports of increased infection or concerning immunosuppressive features. Dual biologic prescribing, furthermore, did not appear to affect asthma control. Further real-world data are required, and use of national registry data could be used to generate more robust safety data.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals of Liverpool group, Liverpool, UK"
      ],
      "name": "H Joplin"
    },
    {
      "affiliations": [
        "University Hospitals of Liverpool group, Liverpool, UK",
        "University of Liverpool, Liverpool, UK"
      ],
      "name": "F Fyles"
    },
    {
      "affiliations": [
        "University Hospitals of Liverpool group, Liverpool, UK"
      ],
      "name": "R Burton"
    },
    {
      "affiliations": [
        "University Hospitals of Liverpool group, Liverpool, UK"
      ],
      "name": "S Zaidi"
    },
    {
      "affiliations": [
        "University Hospitals of Liverpool group, Liverpool, UK"
      ],
      "name": "L Chishimba"
    },
    {
      "affiliations": [
        "University Hospitals of Liverpool group, Liverpool, UK",
        "University of Liverpool, Liverpool, UK",
        "Liverpool School of Tropical Medicine, Liverpool, UK"
      ],
      "name": "H Burhan"
    }
  ],
  "title": "M30 Double or nothing: experience of dual monoclonal antibody prescriptions at a tertiary asthma centre",
  "uid": "d47bca55-b871-5d15-8dda-9d2b080c0df9"
}