adalimumab + methotrexate + ustekinumab

This is a combination therapy consisting of three agents—adalimumab, methotrexate, and ustekinumab—used primarily in the management of refractory or biologic-experienced Crohn’s disease. Adalimumab is a monoclonal antibody targeting tumor necrosis factor alpha (TNF-α), thereby reducing inflammation. Methotrexate is a small molecule antimetabolite that inhibits dihydrofolate reductase, suppressing immune cell proliferation and modulating inflammatory responses. Ustekinumab is a monoclonal antibody that targets the p40 subunit shared by interleukin-12 (IL-12) and interleukin-23 (IL-23), inhibiting their pro-inflammatory signaling pathways. This triple therapy has been reported in case studies to induce clinical remission in patients with Crohn’s disease who have failed previous biologic therapies[1][2]. The rationale for combining these agents lies in their complementary mechanisms of action targeting different inflammatory pathways.