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Triple therapy with adalimumab, ustekinumab and methotrexate for induction of remission in moderate to severe ileocolonic Crohn’s disease with upper gastrointestinal involvement in a biologic-experienced individual
  1. Na Yu,
  2. Dhruv Sarwal,
  3. Ryan Ash and
  4. Florence M Aslinia
  1. Department of Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA
  1. Correspondence to Dr Florence M Aslinia; faslinia{at}kumc.edu

Abstract

Induction of remission in biologic-experienced individuals with moderate to severe Crohn’s disease (CD) can be a challenge. We hereby present a case of CD with secondary non-response to infliximab. Adding methotrexate and switching to ustekinumab plus methotrexate did not stop the inflammatory process. Therefore, combination therapy with two classes of biologics consisting of ustekinumab and adalimumab plus methotrexate was initiated. He achieved clinical remission in 4 weeks and remained on triple therapy for 6 months which was subsequently tailored to adalimumab/methotrexate combination therapy due to insurance restriction on ustekinumab. He remained in remission for the duration of follow-up, 14 months after initiation of triple therapy and 8 months after switching to methotrexate/adalimumab biologic monotherapy. Triple therapy with anti-TNF, IL-12/23 inhibitor and methotrexate could potentially be an option for induction of remission in biologic-experienced individuals with good initial clinical response to anti-TNF agents.

  • drugs: gastrointestinal system
  • endoscopy
  • Crohn's disease
  • inflammatory bowel disease
  • biological agents

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Footnotes

  • Contributors NY and DS contributed equally to this paper. NY and DS prepared the sections and tables of the manuscript. RA and FMA were the attending physicians and supervised the drafting of the manuscript, oversaw the development of the discussion section and provided key images to support the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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