Connecting clinical practice with reported cases
An open-access quality assurance and practice improvement resource documenting reported outcomes and adverse events of concurrent biologic therapy across immune-mediated inflammatory diseases.
Registry model
Open access
The registry connects clinical practice, where cases are managed one at a time, with a single record of what has been reported.
Documented one case at a time, read as one record.
Literature and clinician submissions, reviewed before inclusion.
Open access
No registration, login, or payment required
Two case sources
Published literature and clinician submissions worldwide
No direct identifiers
No names, initials, dates, or record numbers are collected
Background
Biologic Therapies in Immune-Mediated Disease
Biologic medications are among the most significant therapeutic advances in immune-mediated inflammatory disease. The paradigm for prescribing them, however, was set by trials of one agent at a time.
In clinical use across
- Rheumatology
- Gastroenterology
- Dermatology
- Related specialties
A precision approach
Mechanism of action
Conventional therapy
Broad immunosuppression
Effects are exerted across the immune system rather than on a single pathway.
Biologic therapy
One molecular target
Each agent is engineered against a specific pathway involved in disease pathogenesis.
Biologic classes in clinical use
- TNF-alpha inhibitors
- IL-17 inhibitors
- IL-23 inhibitors
- IL-12/23 inhibitors
- IL-4/IL-13 pathway blockers
- Anti-IgE agents
- B-cell depleting therapies
Each class targets a distinct immunologic mechanism across a growing range of indications.
The prevailing paradigm
One agent, one condition
- 01
Trials evaluate one agent
Pivotal studies test a single biologic against placebo or an active comparator in a defined patient population.
- 02
Prescribing follows the trials
The prevailing paradigm remains monotherapy: one biologic agent for one target condition.
- 03Today
Practice moves beyond them
Overlapping immune-mediated conditions and disease refractory to a single agent make concurrent use a clinical consideration.
The Information Gap
Why reported experience is hard to find
Concurrent biologic use is a consideration across gastroenterology, rheumatology, dermatology, and other disciplines, yet published reports have not kept pace with clinical need.
Outside of a small number of emerging studies, the prospective data on concurrent biologic therapy remain limited.
The literature today
By study design
- Emerging
Prospective studies
A small number of emerging studies, primarily in gastroenterology, have begun to explore dual biologic approaches.
- Scattered
Case reports and retrospective analyses
Most of what is available: isolated reports, small case series, and retrospective analyses scattered across journals and specialties.
- Absent
A central record
No centralized resource has existed to gather these reports in one searchable place.
Decisions today rest on
- Individual experience
- Mechanistic extrapolation
- Isolated reports
Physicians increasingly consider biologic combinations without a single place to see what has been reported.
Purpose and Design
Two Sources, One Record
The registry was created to give clinicians one place to review reported experience, drawn from two complementary sources.
Published literature
Cases documented in peer-reviewed journals are identified, extracted, and catalogued in a standardized format.
Study types
- Case reports
- Case series
- Observational studies
Brings in
Published cases, gathered in one place.
Clinical submissions
Healthcare professionals submit cases through a structured, data-minimized template that collects no direct identifiers.
Reviewed before inclusion for
- Completeness
- Clinical plausibility
- Consistency
Brings in
Clinical experience that would otherwise go unreported.
Why two sources
Reported experience alongside trials
Randomized controlled trials
One agent, a defined population, and a controlled comparison.
Registry cases
Comorbidity, overlapping disease, and combinations that trials exclude.
A fuller clinical picture
Trial results read alongside experience from everyday practice.
Clinical scope
What the Registry Captures
The registry spans a broad range of immune-mediated inflammatory diseases and records the same set of clinical and demographic variables for every case, whether drawn from the literature or submitted by a clinician.
- Agents per case
- Two or more, at least one of which is a biologic
- Data sources
- Published literature and clinical submissions worldwide
- Direct identifiers
- None collected
Registry case record
No direct identifiersPatient
Demographics
Age bracket and sex.
Primary diagnosis
Disease category and relevant comorbid conditions.
Therapy
Advanced therapies
The concurrent agents prescribed, comprising biologics and targeted oral therapies. At least two agents per case, at least one of which is a biologic.
Duration of therapy
Length of concurrent advanced therapy.
Concomitant medications
Conventional systemic medications administered alongside the advanced therapies.
Outcome
Disease activity measures
OptionalAbsolute scores at baseline and follow-up, with the follow-up interval. Reported with completeness where available.
Validated instruments such as
- PASI
- BSA
- DAPSA
- ASDAS
- MDA
- LEI
Clinical outcome
Categorized on a standardized scale.
Scale
- Complete remission
- Well controlled
- Improvement
- Mixed
- No response
Adverse events
Any adverse events observed during the treatment period.
For Clinicians
What the Registry Offers
To date, no other centralized resource has been dedicated specifically to bringing together reported cases of concurrent biologic therapy.
One Place to Look
Cases that would otherwise remain scattered across journals and specialties, or unreported in practice, are gathered in one searchable record.
Search by
- By combination
- By diagnosis
- By region
Adverse Events Alongside Outcomes
Each reported adverse event is shown with the outcome of the same case, regardless of severity or attribution.
Shows
- All reported events
- No causality implied
- Case-level detail
Linked to the Source
Every published case comes from a peer-reviewed source in the registry's reference list, with a DOI link to the original article.
Sources
- Peer-reviewed sources
- DOI links
- Full report access
Open Access
Free to use without registration or login, independent of industry funding, and open to contributions from clinicians worldwide.
Access
- No login
- No industry funding
- International
Leadership
Led by CMSD
The Concurrent Biologics Registry is led by Dr. Maksym Breslavets and managed through the Centre for Medical and Surgical Dermatology, supporting informed decision-making when concurrent biologic therapy is considered.
Governance
Registry oversight
- Registry director
Dr. Maksym Breslavets
- MD
- PhD
- FRCPC
- FAAD
- Managed through
Centre for Medical and Surgical Dermatology (CMSD)
- Registry operations
- Clinical oversight
- Role in practice
A quality assurance tool for clinical practice
- Informed decision-making
- When concurrent therapy is considered
Contributors
Project Contributors
The Concurrent Biologics Registry is built through clinical leadership, structured literature review, and platform development.
Chelsea Butler, BSc
Literature Curator
Medical student, University of Ottawa Faculty of Medicine
Structured searches of published concurrent therapy cases and ongoing curation of the foundational dataset across treatment, outcome, and demographic variables.
Contributions
- Literature review
- Case extraction
- Data curation
Behind the Registry
Operated by CMSD, Built by Dermi
The Centre for Medical and Surgical Dermatology operates the registry, and Dermi, a Toronto-based healthcare technology company, built and maintains the technical platform. Both contribute on a volunteer basis.
Operates
CMSD
Centre for Medical and Surgical Dermatology
Operates the registry and provides the clinical leadership and governance behind it.
Responsible for
- Registry operations
- Clinical leadership
Builds and maintains
Dermi
Toronto-based healthcare technology company
Built and maintains the technical platform, bringing its privacy-by-design approach to the registry.
Known for
- Local-first software
- Privacy by design
Principles applied to the registry
Privacy by design
Protections are enforced through architecture rather than policy alone.
Data minimization
While the registry is centrally hosted, only what is strictly necessary is collected.
Funding and compensation
- Volunteer initiative
- Free of charge
- No compensation
- No industry funding
The Concurrent Biologics Registry is a volunteer initiative of CMSD and Dermi, provided free of charge. CMSD contributes clinical leadership and curation, and Dermi contributes the technical platform. Neither receives compensation for this work, and the registry receives no pharmaceutical industry funding. Pharmaceutical companies and drug manufacturers play no role in the scope, methodology, or content of the registry.
Outside of the registry, CMSD partners with Dermi to provide open-access clinical resources, including dermatology calculators such as PASI, EASI, VASI, and IHS4, freely available at cmsderm.ca/calculators.
Privacy
Patient Privacy as a Foundational Principle
The registry is designed so that no direct patient identifiers are collected. The submission template captures only a minimal set of structured clinical variables.
Read the Privacy PolicyCollected
Structured clinical variables only
- Age bracket and sex
- Disease category
- Advanced therapies
- Duration of therapy
- Clinical outcomes
- Adverse events
Never requested
Direct identifiers
- Names
- Dates of birth
- Treatment dates
- Assessment dates
- Record numbers
- Addresses
No direct identifiers are requested at any stage, and every submission is screened before inclusion.