COMBINATION BIOLOGIC AND SMALL MOLECULE THERAPY FOR REFRACTORY ULCERATIVE COLITIS

Abstract INTRODUCTION Some inflammatory bowel disease (IBD) patients do not achieve remission with maximal medical therapy. We present a case of refractory UC who achieved clinical, endoscopic, and histologic after combining biologic small molecule CASE DESCRIPTION A 25-year-old Caucasian male was referred to our clinic for UC. Since diagnosis four years prior, he failed mesalamine, azathioprine (intolerant), adalimumab (secondary nonresponse), vedolizumab nonresponse) inability taper prednisone. Upon presentation at week 14 infliximab therapy without clinical improvement. Therapeutic drug monitoring revealed adequate levels antibodies. Colonoscopy mayo 2-3 discrete ulcerations (Figure 1). Due primary non-response, initiated on ustekinumab (UST). He remained clinically active despite dose escalation up evey weeks prednisone use. Tofacitinib initial improvement, then worsening 3 months. The dosing increased from twice daily three times repeat colonoscopy pan-colitis Mayo 2 disease. the patient started combined tofacitinib UST. On dual experienced progressive After year treatment showed no activity, biopsies evidence cryptitis, or crypt abscesses infiltrate 2). DISCUSSION This highlights benefit combination in medically IBD. There are limited prospective data endorse widespread implementation meta-analysis thirty studies, involving 279 patients, reported 59% were able 34% endoscopic therapy1. Concerns safety continue be evaluated. In case, UST adverse effects. this support efficacy patients. REFERENCES Ahmed W, Galati J, Kumar et al. Dual Biologic Small Molecule Therapy Treatment Inflammatory Bowel Disease: Systematic Review Meta-analysis. Clin Gastroenterol Hepatol 2021. https://doi.org/10.1016/j.cgh.2021.03.034.