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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).
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：关于使用两种或多种生物制剂治疗免疫介导疾病的安全性和有效性知之甚少，包括克罗恩病（CD）。
方法：本病例报告和叙述性综述证明了双重生物疗法（DBT）在一名45岁女性患者中的潜在安全性，该女性患有两种独立的免疫介导的疾病。她有多发性硬化症的病史，正在接受奥克瑞珠单抗的治疗，她最近在腹泻后被诊断出患有CD。CD诊断通过放射学证实，内窥镜,组织学上,和生物化学。患者接受维多珠单抗治疗，白细胞上α4β7整合素的肠特异性抑制剂。在治疗期间没有观察到不良反应。证明了奥克瑞珠单抗和维多珠单抗治疗不同免疫介导疾病的安全性。
结论：DBT可能是治疗难治性疾病或多种免疫介导疾病的安全有效选择。较新的生物制品，提高了安全性和肠道特异性，可能为治疗提供有希望的途径。然而,鉴于生物制剂固有的免疫抑制特性，在适当选择生物制剂时必须谨慎行事，副作用,和功效概况。目前的证据表明，2019年冠状病毒病患者的生物治疗与预后较差无关，但治疗决策应在多学科环境中做出。需要从对照试验中进行进一步研究，以更好地了解CD中DBT的安全性。DBT的免疫病理学机制也有待阐明。
方法：本病例报告和叙述性综述证明了双重生物疗法（DBT）在一名45岁女性患者中的潜在安全性，该女性患有两种独立的免疫介导的疾病。她有多发性硬化症的病史，正在接受奥克瑞珠单抗的治疗，她最近在腹泻后被诊断出患有CD。CD诊断通过放射学证实，内窥镜,组织学上,和生物化学。患者接受维多珠单抗治疗，白细胞上α4β7整合素的肠特异性抑制剂。在治疗期间没有观察到不良反应。证明了奥克瑞珠单抗和维多珠单抗治疗不同免疫介导疾病的安全性。
结论：DBT可能是治疗难治性疾病或多种免疫介导疾病的安全有效选择。较新的生物制品，提高了安全性和肠道特异性，可能为治疗提供有希望的途径。然而,鉴于生物制剂固有的免疫抑制特性，在适当选择生物制剂时必须谨慎行事，副作用,和功效概况。目前的证据表明，2019年冠状病毒病患者的生物治疗与预后较差无关，但治疗决策应在多学科环境中做出。需要从对照试验中进行进一步研究，以更好地了解CD中DBT的安全性。DBT的免疫病理学机制也有待阐明。
