Dual biologic therapy with ocrelizumab for multiple sclerosis and vedolizumab for Crohn’s disease: A case report and review of literature

doi:10.12998/wjcc.v10.i8.2569

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Mar 16, 2022; 10(8): 2569-2576
Published online Mar 16, 2022. doi: 10.12998/wjcc.v10.i8.2569

Dual biologic therapy with ocrelizumab for multiple sclerosis and vedolizumab for Crohn’s disease: A case report and review of literature

Michael Au, Nikola Mitrev, Rupert W Leong, Viraj Kariyawasam

Michael Au, Department of Gastroenterology and Hepatology, Blacktown and Mt Druitt Hospitals, Western Sydney Local Health District, Sydney 2148, New South Wales, Australia

Michael Au, Viraj Kariyawasam, Blacktown Clinical School, Western Sydney University, Blacktown 2148, New South Wales, Australia

Nikola Mitrev, Department of Gastroenterology and Hepatology, Blacktown Hospital, Western Sydney Local Health District, Blacktown 2148, New South Wales, Australia

Rupert W Leong, Endoscopy Department and Inflammatory Bowel Disease Service, Concord Hospital, Sydney 2137, New South Wales, Australia

Rupert W Leong, Concord Clinical School, University of Sydney, Sydney 2137, New South Wales, Australia

Viraj Kariyawasam, Inflammatory Bowel Disease Service, Blacktown Hospital, Western Sydney Local Health District, Blacktown 2148, New South Wales, Austria

Author contributions: Au M compiled data, reviewed records, performed literature review, and wrote first draft; Mitrev N and Kariyawasam V reviewed records, reviewed literature, and reviewed draft; Leong RW reviewed records.

Informed consent statement: All involved persons (subjects or legally authorised representative) gave their informed consent prior to study inclusion.

Conflict-of-interest statement: Dr Rupert W Leong is currently serving on the advisory boards of AbbVie, Aspen, BMS, Celgene, Chiesi, Ferring, Glutagen, Hospira, Janssen, MSD, Novartis, Pfizer, and Takeda. The authors declare no other conflicts of interest.

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).

Corresponding author: Michael Au, MBBS, Doctor, Department of Gastroenterology and Hepatology, Blacktown and Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown and Mt Druitt Hospitals, Sydney 2148, New South Wales, Australia. michael.au@my.jcu.edu.au

Received: September 1, 2021
Peer-review started: September 1, 2021
First decision: November 7, 2021
Revised: November 21, 2021
Accepted: February 10, 2022
Article in press: February 10, 2022
Published online: March 16, 2022
Processing time: 190 Days and 7.9 Hours

Abstract

BACKGROUND

Little is known about the safety and efficacy of using two or more biologics for the treatment of immune-mediated diseases, including Crohn’s disease (CD).

CASE SUMMARY

This case report and narrative review demonstrate the potential safety of dual biologic therapy (DBT) in a 45-year-old female with two separate immune-mediated diseases. She had a history of multiple sclerosis for which she was receiving treatment with ocrelizumab, and she had been recently diagnosed with CD after presenting with diarrhoea. The CD diagnosis was confirmed radiologically, endoscopically, histologically, and biochemically. The patient received treatment with vedolizumab, a gut-specific inhibitor of the α₄β₇ integrin on leukocytes. No adverse reactions were observed for the duration of treatment. The safety of ocrelizumab and vedolizumab for the treatment of different immune-mediated diseases was demonstrated.

CONCLUSION

DBT may be a safe and effective option for the treatment of refractory disease or multiple immune-mediated diseases. Newer biologics, which have improved safety profiles and gut specificity, may provide promising avenues for treatment. However, caution must be exercised in the appropriate selection of biologics given their inherent immunosuppressive properties, side effects, and efficacy profiles. Current evidence suggests that biologic therapy is not associated with a worse prognosis in patients with coronavirus disease 2019, but treatment decisions should be made in a multidisciplinary setting. Further research from controlled trials is needed to better understand the safety profile of DBT in CD. The immunopathological mechanisms underlying DBT also remain to be clarified.

Keywords: Dual biologic therapy; Combination; Immunosuppression; Safety; Autoimmune; Case report

Core Tip: This paper describes the use of two biologics for the treatment of Crohn's disease and multiple sclerosis. Only a few papers have reported the safety and efficacy of these treatments due to inherent concerns regarding immunosuppression, infection, and malignancy. We present the case of a patient who was safely treated with vedolizumab and ocrelizumab. The combination of biologics may be a safe and effective treatment for immune-mediated diseases.