A 17-Year-Old Male Adolescent With Refractory Crohn’s Disease Managed With Upadacitinib and Risankizumab Combination Therapy: A Case Report and Review of Current Evidence

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.