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Real members of myRAteam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.

Combination therapy

A myRAteam Member asked a question 💭
Northern Ireland

Has anyone been in combination therapy? I had a cytokine panel done and I have 6 active cytokines, hence biologics haven't really worked. The next step is combination therapy, but I have type 1 diabetes and had a heart attack in 2025 so I'm worried about the increased immunosuppression on 2 biologics, and they are recommending inflixumab with ixekizumab which could have cardiac implications.

13 hours ago
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A myRAteam Member

Gastro docs are the same way. One of the biologic meds could give you gastric issues. I already had that. So the rheumatologist wanted me to ask the gastro. They had no idea!!! Frustrating.

12 hours ago
A myRAteam Member

Cardiologists don't understand biologics. They weren't able to understand the role that filgotinib had in my heart attack. I wood say their input wouldn't help much.

12 hours ago
myRAteam

What are the risks and considerations for combination biologic therapy in RA, especially with a cardiac history and type 1 diabetes?

This is a really important and complex situation, and it's completely understandable to have concerns. With 6 active cytokines and biologics not working well individually, a combination Show Full Answer

What are the risks and considerations for combination biologic therapy in RA, especially with a cardiac history and type 1 diabetes?

This is a really important and complex situation, and it's completely understandable to have concerns. With 6 active cytokines and biologics not working well individually, a combination approach makes clinical sense — but the risks deserve serious discussion with your rheumatologist and cardiologist together.

Here are some key considerations to be aware of:

Regarding combining two biologics:
- Using multiple biologic DMARDs simultaneously can significantly suppress the immune system
- This raises the risk of serious, potentially life-threatening infections
- This combination is generally approached with great caution and requires close monitoring Regarding your cardiac history:
- Cardiovascular risk is already a known comorbidity in RA
- Adding immunosuppression after a cardiac event warrants very careful specialist input
- A joint consultation between your rheumatologist and cardiologist before starting this regimen would be strongly advisable

Questions worth raising with your medical team:
- What infection screening and monitoring protocols will be in place?
- Are there any sequential (rather than simultaneous) biologic strategies that could reduce risk?
- What cardiac monitoring will accompany this treatment plan?

Some myRAteam members have shared experiences with combination therapies, but given your specific cardiac and immune history, this really needs to be a deeply personalized conversation with your specialists. Don't hesitate to ask for a second opinion — a situation this complex absolutely warrants one. 💙

13 hours ago

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