Amber Cloud, MD1, Deborah R. Flomenhoft, MD2 1University of Kentucky, Lexington, KY; 2University of Kentucy, Lexington, KY
Introduction: Golimumab is not currently approved for treatment of Crohn disease (CD). Several case series report efficacy in patients with refractory disease and loss of response to approved anti TNFs. Current studies are investigating golimumab alone and in combination with guselkumab for patients with moderate to severe CD. Here we report a patient with severe refractory CD who achieved ongoing remission with golimumab and azathioprine (AZA) in combination with guselkumab for psoriasis and delivered a healthy infant at 37w2d.
Case Description/Methods: 26 y F was diagnosed at age 13 w/ severe stricturing ileocolonic CD with perianal involvement. Initially the patient was started on infliximab monotherapy (low intermediate TPMT) with clinical response but developed an anaphylactic reaction. Adalimumab and MTX were started with clinical response and endoscopic improvement, but histologic activity. She endorsed poor compliance with MTX due to side effects. She noted psoriasiform rash with adalimumab and difficulty with frequency of dosing. She transitioned to ustekinumab, but had progression of disease requiring ileocolonic resection and treatment of perianal disease. Post-op certolizumab failed clinically, worsened psoriasis and was changed to adalimumab. On reinduction she had high titer antibodies. She failed vedolizumab: she had worsened anemia and weight loss. Anti TNF afforded her best response: golimumab with AZA was initiated 2020 with improvement in CD symptoms but worsened psoriasis. Dermatology started guselkumab with improvement in psoriasis.
Initiation of golimumab corresponded to normalization of CRP, resolution of anemia, weight gain, and histologic remission. Diarrhea and incontinence resolved. After two years’ remission she became pregnant. She developed hypertension in the third trimester, managed with labetalol. She delivered a healthy 2800g male infant via elective C/S at 37w2d.
Discussion: Golimumab is an injectable anti-TNF agent approved for ulcerative colitis. It is not approved for CD. Insurance often fails to cover this anti TNF, which has not been studied in CD, despite case series reporting long-term efficacy in refractory patients.
Here we report a case of a patient with severe CD who achieved long-term remission with golimumab. It appears safe in conjunction with a second biologic as she has been receiving guselkumab for her psoriasis. She has also had a successful pregnancy on this therapy and delivered an AGA, healthy infant
Amber Cloud indicated no relevant financial relationships.
Amber Cloud, MD1, Deborah R. Flomenhoft, MD2. P0827 - Patient with Severe Refractory Crohn's Disease Achieved Remission on Golimumab with Guselkumab for Psoriasiform Rash and Delivered Healthy Term Infant, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.