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Background and Importance Refractory inflammatory bowel disease is challenging to treat; IL-23 inhibitors offer new options, but their combination with other biologics lacks formal evidence and should be used cautiously with close monitoring due to the potential increased risk of immunosuppression.Aim and Objectives To describe the clinical experience with the combination of risankizumab and other biologic drugs in patients with refractory inflammatory bowel disease, evaluating its clinical efficacy, progression, and safety profile.Material and Methods A retrospective case series including patients diagnosed with inflammatory bowel disease who received combined treatment with risankizumab and another biologic drug between January 2024 and August 2025. Clinical and therapeutic data were collected from electronic medical records, including age, sex, disease duration, prior treatments, reason for combination, drugs and duration of combination, C-reactive protein (CRP) and faecal calprotectin levels, adverse events (AE), and treatment changes. Data were analysed descriptively clinical evolution and tolerability.Results Five patients were included (median age: 62 years; 80% male), four with Crohn’s disease and one with ulcerative colitis (UC). Most had ileal involvement, and three also had perianal disease, with a long disease course (median 26 years, range 10–44) and multiple prior biologic treatments (mean 3.2). The combination of risankizumab with another biologic was prescribed due to persistent inflammatory activity, using infliximab (n=3), adalimumab (n=1), or vedolizumab (n=1), for durations ranging from 3 to over 5 months. Faecal calprotectin decreased significantly by an average of 1420.33 points (range 533–1958) in 3 of 4 patients, although only one reached levels below 200; in the UC patient, levels increased. CRP decreased in all evaluable patients. No moderate or severe adverse reactions were recorded. At the end of follow-up, two patients continued on risankizumab monotherapy, while three maintained the combination therapy.Conclusion and Relevance In this case series, the combination of risankizumab with other biologic treatments showed a favourable clinical response in most patients, with good tolerability and no significant AEs. These results suggest that, in selected clinical situations, this combination could be considered as a rescue therapeutic option. Since there are no guidelines supporting this combination, its use should be individualised and carefully supervised, with the hospital pharmacist playing a key role in evaluation and monitoring.Conflict of Interest No conflict of interest