Dual biologic therapy in inflammatory bowel disease, a retrospective cohort study of vedolizumab and anti-tumor necrosis factor alpha therapy in children.

What To Know

This retrospective pediatric cohort study examined dual biologic therapy combining an anti-TNF-α agent and vedolizumab in children with inflammatory bowel disease who were refractory to biologic monotherapy.

Over 6–12 months of follow-up (22 treatment episodes in 21 children), steroid-free clinical remission rose from 9% at baseline to 68% at 3 months and 50% at 12 months among those remaining on therapy; 72% achieved remission at some point during follow-up. Endoscopic and histologic remission rates and fecal calprotectin levels also improved for many patients.

Serious infections were reported: one case of pulmonary mucormycosis and one of herpes simplex keratitis. Some children still required surgery during follow-up. The study is retrospective, relatively small, and from a single cohort, which limits how confidently results can be generalized.

If you are a caregiver or clinician considering combined biologic therapy for a child who has not responded to a single biologic, this study adds real-world pediatric data suggesting benefit for many patients but also highlights infectious risks and the need for close monitoring.

Discussion with a pediatric gastroenterology team experienced in complex IBD management is important.