Abstract
<title>Abstract</title> <p>Background: Inflammatory bowel disease is a chronic immune-mediated disorder where a subset of patients develops refractory disease despite treatment with advanced therapies. Dual targeted therapy (DTT), the concurrent use of two targeted agents with different mechanisms of action, has emerged as a potential strategy for this highly challenging patient population. However, real-world data on the effectiveness and safety of DTT, particularly from the Middle East, remain scarce. Aims: This study aimed to evaluate the real-world outcomes of DTT in adult patients with refractory Inflammatory bowel disease in Qatar. Methods: We conducted a retrospective, observational study of adult patients with refractory Crohn’s disease (CD) or Ulcerative colitis (UC) who received DTT for at least eight weeks between January 2020 and May 2025 at two IBD referral center in Qatar. Data on patient demographics, disease characteristics, treatment history, and clinical, endoscopic, and safety outcomes were extracted from electronic medical records. Clinical remission was defined as a Harvey-Bradshaw Index (HBI) ≤4 for CD and a Mayo Clinic Score ≤2 for UC. Endoscopic remission was defined as a Simple Endoscopic Score for Crohn’s Disease (SES-CD) ≤2 or a Mayo endoscopic sub-score of 0–1. Results: A total of 24 patients (14 CD, 10 UC) were included, with a median age of 46.0 years and a median of three prior failed biologic therapies. The median duration of DTT was 47.0 weeks. In the overall cohort, 45.8% of patients achieved clinical remission, with a statistically significant association observed between the specific DTT combination and remission rates (p=0.027); the combination of infliximab plus ustekinumab was most effective, achieving remission in 80% of patients. Endoscopic remission was observed in 39.1% of patients. Adverse events were uncommon, occurring in only three patients (12.5%): two cases of anemia and one fungal infection, all of which were managed conservatively. Conclusions: In this real-world cohort of highly refractory Inflammatory bowel disease patients in the Middle East, dual targeted therapy was associated with substantial rates of clinical and endoscopic remission. The safety profile was favorable, with adverse events occurring in only 12.5% of patients. In this cohort, DTT appeared to be an effective and safe rescue strategy for patients with refractory Inflammatory bowel disease in this region, warranting further prospective evaluation to confirm long-term outcomes.</p>