A 17-Year-Old Male Adolescent With Refractory Crohn's Disease Managed With Upadacitinib and Risankizumab Combination...

BACKGROUND Crohn's disease (CD) is an autoimmune disorder affecting the gastrointestinal tract, particularly the terminal ileum and colon. Moderate-to-severe CD is often managed with advanced therapeutic approaches, including biologics and small molecules. Several studies and reports have shown that new immunosuppressive biologics are effective as second-line therapies in patients with refractory CD, including upadacitinib (a JAK1 inhibitor) and risankizumab (interleukin-23 p19 inhibitor). CASE REPORT We report a case of a 17-year-old male adolescent with a 7-year history of CD. The patient experienced response failure to infliximab and adalimumab, despite both agents being maintained within the therapeutic range. He was steroid-dependent. His infectious workup was repeatedly negative. He was started on ustekinumab, which was stopped after 9 months due to active endoscopic disease. This was followed by an induction course of upadacitinib, which resulted in only a partial response, with a fecal calprotectin level of 500 mcg/g. Finally, he was treated effectively with advanced combined targeted therapy, with oral upadacitinib at a dose of 45 mg daily and risankizumab induction dose of 600 mg intravenously at 0, 4, and 8 weeks, followed by 360 mg subcutaneously every 8 weeks. The patient achieved complete clinical and biochemical remission. At 9 months, his repeat colonoscopy showed quiescent disease, with a Simple Endoscopic Score for Crohn's disease score <4. CONCLUSIONS This report supports recent regulatory approvals, reports, and study findings that have shown the effectiveness of upadacitinib and risankizumab as second-line therapy in patients with refractory inflammatory bowel disease.