Case Report: Safety and efficacy of combination therapy with adalimumab and anakinra in two patients with severe inflammatory diseases

Background: Chronic inflammatory diseases in children can involve distinct immunologic pathways, occasionally necessitating dual biologic therapy when single-agent treatment is insufficient. Evidence on combined IL-1 and TNF-α inhibition remains limited. Cases: A 15-year-old girl with ulcerative colitis and recurrent pericarditis received adalimumab and anakinra, achieving clinical remission without infections over eight months. An 11-year-old boy with juvenile idiopathic arthritis, uveitis, and colchicine-resistant familial Mediterranean fever received combined adalimumab and anakinra, achieving low disease activity in both conditions at six months, without adverse events. Discussion: Dual blockade of TNF-α and IL-1 may be rational in selected patients due to overlapping and complementary roles of these cytokines in driving inflammation. Our cases illustrate that this combination can be effective and well tolerated with careful monitoring. Conclusion: In carefully selected pediatric patients, simultaneous TNF-α and IL-1 inhibition may provide clinical benefit. Further studies are required to assess long-term safety and efficacy.