Background- Loss of response (LOR) to a single biological agent after previous failure of immunomodulators is a frequent event complicating the treatment of severe Crohn's disease. Some patients may also lose response to a second biological agent, often exhausting all current medical therapies despite active disease. A new strategy for LOR is Reinduction of a previously failed biologic along with MTX. Reinduction guarantees higher trough levels than decreasing dose intervals, and MTX acts as a second agent for remission which might also impair formation of anti drug AB.- Retrospective analysis of Crohn’s disease patients in a pediatric IBD center, who developed LOR to two biologic agents and relapsed despite dose or interval changes.All patients had lost response to both Infliximab and Adalimumab and all had received a prior immunomodulater. All underwent a second induction (Reinduction treatment) with Adalimumab combined with Methotrexate (doses 10-15 mg/m2) one patient received Infliximab for reinduction treatment. Response to treatment was defined as decrease in clinical and laboratory disease activity whereas remission was defined as complete absence of clinical symptoms ( PGA) . Data on mucosal healing was collected for those who underwent a colonoscopy after reinduction. 12 Crohn’s patients with LOR underwent a reinduction treatment. mean age at presentation was 16.5 years (12-26), mean age of diagnosis was 12.7 years (7.5-17). 8 males and 4 females.Overall response to treatment was achieved in 9 patients (75%), while 7 (58.3%) reached a complete clinical remission.3 (25%) patients failed to respond. 6 patients out of the remission group underwent a colonoscopy demonstrating a complete mucosal healing in 3 patients. Reinduction of a previously failed biologic along with Methotrexate is a promising strategy for treatment of patients who lose response to two biological agents and exhaust all current medical therapies.
