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Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2025; 31(47): 113381
Published online Dec 21, 2025. doi: 10.3748/wjg.v31.i47.113381
Dual biologic therapy in patient with refractory ulcerative colitis and comorbidities: A case report
Andreia C Guimarães, Rocio Ferreiro-Iglesias, Cristina Calviño-Suarez, Iria Baston-Rey, Manuel Barreiro-de Acosta
Andreia C Guimarães, Department of Gastroenterology, Local Health Unit of Braga, Braga 4710-243, Portugal
Rocio Ferreiro-Iglesias, Cristina Calviño-Suarez, Iria Baston-Rey, Manuel Barreiro-de Acosta, Department of Gastroenterology, University Hospital Santiago de Compostela, Santiago de Compostela 15706, Galicia, Spain
Rocio Ferreiro-Iglesias, Cristina Calviño-Suarez, Iria Baston-Rey, Manuel Barreiro-de Acosta, Fundación Pública Galega, Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela 15706, Galicia, Spain
Author contributions: Guimarães AC conceived and designed the study; Ferreiro-Iglesias R, Calviño-Suarez C, Baston-Rey I, and Barreiro-de Acosta M contributed to the critical review of the manuscript; all authors read and approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this anonymized case report and any accompanying images.
Conflict-of-interest statement: Guimarães AC has received support for attending scientific meetings and/or travel from Takeda, Pfizer, Tillotts Pharma Iberia; Ferreiro-Iglesias R has received grants or contracts from AbbVie, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AbbVie, Falk, MSD, Janssen, Takeda, Pfizer, Tillotts, Diasorin, Adacyte, Kern, and Chiesi, support for attending meetings and/or travel from AbbVie, Falk, MSD, Janssen, Takeda, Pfizer, Tillotts, Diasorin, Adacyte, Kern, and Chiesi, has participated on a Data Safety Monitoring Board or Advisory Board for AbbVie and Janssen, and holds a leadership or fiduciary role as a member of the board of GETECCU; Calviño-Suarez C has received support for attending scientific meetings and/or travel from AbbVie, Janssen, Takeda, Adacyte, Fresenius Kabi, and Lilly; Baston-Rey I has received grants or contracts from AbbVie, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AbbVie, Takeda, Johnson and Johnson, support for attending meetings and/or travel from Johnson and Johnson, AbbVie, Takeda, Pfizer, and Adacyte, and has participated on a Data Safety Monitoring Board or Advisory Board for Johnson and Johnson; Barreiro-de Acosta M has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from MSD, AbbVie, Janssen, Takeda, Alphasigma, Lilly, Pfizer, Sandoz, Biocon, Abivax, Diasorin, Oncostellae, and SunRock, support for attending meetings and/or travel from AbbVie, Janssen, Takeda, Alphasigma, Lilly, and Pfizer, and has participated on a Data Safety Monitoring Board or Advisory Board for MSD, AbbVie, Janssen, Kern Pharma, Celltrion, Takeda, Alphasigma, Lilly, and Pfizer.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andreia C Guimarães, MD, Department of Gastroenterology, Local Health Unit of Braga, Sete Fontes, Sao Victor, Braga 4710-243, Portugal. andreiaguimaraes32@gmail.com
Received: August 25, 2025
Revised: September 27, 2025
Accepted: November 4, 2025
Published online: December 21, 2025
Processing time: 118 Days and 10.3 Hours
Abstract
BACKGROUND

Despite advances in the treatment of ulcerative colitis (UC), some patients remain refractory to the currently available treatments. Dual biologic therapy (DBT) has emerged as a promising strategy for these patients.

CASE SUMMARY

A patient with extensive UC presented with steroid dependence and contraindications (past medical history included breast cancer and previous myocardial infarction) to treatment with tumor necrosis factor and Janus kinase inhibitors. DBT of α4β7 integrin antagonist (vedolizumab) and interleukin 23p19 inhibitor (mirikizumab) resulted in a sustained clinical and biochemical remission. No adverse events were recorded during the follow-up.

CONCLUSION

This case highlighted the challenge of managing refractory UC, especially in frail patients.

Keywords: Inflammatory bowel disease; Refractory ulcerative colitis; Combination therapy; Mirikizumab; Vedolizumab; Case report

Core Tip: Dual biologic therapy (DBT) is a promising treatment option for patients with refractory ulcerative colitis (UC) who have limited therapeutic alternatives. We presented the first case of a patient with extensive UC treated with mirikizumab and vedolizumab due to contraindications to tumor necrosis factor and Janus kinase inhibitors. The combination of mirikizumab and vedolizumab led to sustained clinical and biochemical remission without adverse events. Our case highlighted the therapeutic potential and safety of DBT in selected patients, reinforcing the need for individualized treatment strategies in complex clinical scenarios.