Triple biologic therapy for refractory Crohn's disease
Sophie Vieujean1,2, Laurent Peyrin-Biroulet2
1Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium.
Journal of Crohn'S & Colitis
|April 19, 2025
Summary
Triple biologic therapy for refractory Crohn's disease (CD) showed no benefit in a complex case with concurrent ankylosing spondylitis. This experimental approach requires further investigation for efficacy and safety in select patients.
Area of Science:
- Gastroenterology
- Immunology
- Rheumatology
Background:
- Crohn's disease (CD) management faces challenges with refractory cases.
- Dual-targeted therapy (DTT) shows promise, but triple biologic therapy is rarely reported.
- Overlapping immune-mediated conditions complicate treatment decisions.
Purpose of the Study:
- To report a rare case of triple biologic therapy in a patient with refractory Crohn's disease and ankylosing spondylitis.
- To evaluate the efficacy and tolerability of a specific triple biologic combination.
- To highlight the complexities of managing refractory inflammatory bowel disease with comorbidities.
Main Methods:
- Case report of a 30-year-old male with refractory CD and ankylosing spondylitis.
- Patient received multiple prior therapies including anti-TNF agents, vedolizumab, ustekinumab, and upadacitinib.
- Initiated triple biologic therapy with certolizumab pegol, ustekinumab, and vedolizumab for 10 months.
Main Results:
- Triple biologic therapy was well-tolerated.
- Ankylosing spondylitis remained in remission.
- No clinical improvement was observed in Crohn's disease activity.
Conclusions:
- Triple biologic therapy is experimental for refractory IBD with comorbidities.
- Effectiveness of triple therapy remains uncertain and requires cautious approach.
- Further research is needed to identify suitable patients and optimal combinations for triple therapy.
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