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Abstract Background Immune checkpoint inhibitors (ICPIs) are increasingly being used in the treatment of a variety of malignancies. The original studies that demonstrated the efficacy of ICPIs excluded patients actively being treated for autoimmune conditions, and there is only limited evidence that these treatments are safe and effective in this population of patients. Case presentation We present a case of a man with Crohn’s disease actively requiring immunosuppressive therapy who subsequently received pembrolizumab for metastatic melanoma. He had no further progression of metastatic disease and had resolution of his pulmonary nodule while he experienced no Crohn’s disease flares or immune related adverse events. We surveyed the existing literature for studies examining the use of ICPIs in patients with autoimmune disorders and reviewed the unique mechanism of action of the α4β7 inhibitor, vedolizumab. Conclusion Patients with autoimmune conditions should be considered candidates for immune checkpoint inhibition even in the setting of active immunosuppressive therapy. The mechanism of action of immunosuppressive therapy should be considered with the most targeted form of treatment being used when possible. Further prospective studies investigating immunotherapy in patients with autoimmune conditions are warranted.

The development of biologic therapies for Crohn's disease and ulcerative colitis has profoundly affected the treatment of these diseases. The impact of these novel therapies has been tremendous in terms of their ability to cause clinical improvement in symptoms and endoscopic and histologic evidence of healing, as well as improvements in quality of life. However, the success of these new remedies comes with a significant price tag. In the current cost-containment environment of health care, it is essential to evaluate the impact of these novel and promising therapies on health care resource utilization, employment productivity, and quality of life. Despite the high cost of these new medications, they may result in a net cost savings through their ability to induce remission in the sickest of inflammatory bowel disease (IBD) patients, thereby averting the large expenditures associated with hospitalization and surgery. Likewise, by improving patients' physical symptoms, emotional well-being, and quality of life, biologic agents have the potential to reduce much of the unemployment, missed work, and disability through which IBD patients suffer. In a disease with an early age of onset and a chronic course with normal life expectancy, reducing morbidity and improving quality of life should be important measures of treatment success. Biologic therapies for IBD hold significant promise in this regard, allowing clinicians to achieve lasting remission in patients who are unresponsive to conventional therapies. Comparison of the costs and benefits of biologic therapies with conventional treatments for IBD is complicated by the need to assess the downstream effects of an intervention. For example, corticosteroids are inexpensive and very effective for induction of remission, but they come with significant long-term complications, such as osteoporosis, cataracts, impaired glucose tolerance, and poor wound healing, which must be taken into account when assessing their true cost as a maintenance medication. We do not yet have enough experience with biologic therapies to evaluate their potential to prevent or create future costs associated with adverse effects. However, as we move forward with our knowledge of biologic agents, an understanding of the economic and quality-of-life implications of these innovative therapies is crucial for patients, clinicians, and third-party payers alike.