Initial advanced therapy suggested over step therapy involving corticosteroids and/or immunomodulators
WEDNESDAY, Nov. 26, 2025 (HealthDay News) — Early use of higher-efficacy therapies is recommended for patients with moderately to severely active Crohn disease (CD), according to a living clinical practice guideline issued by the American Gastroenterology Association (AGA) and published online Nov. 20 in Gastroenterology.
Frank I. Scott, M.D., from the University of Colorado Anschutz School of Medicine in Aurora, and colleagues developed a living guideline to support practitioners in the pharmacologic management of moderately to severely active CD.
The panel agreed on 16 recommendations: one strong and nine conditional; six were identified as knowledge gaps. The AGA recommends use of infliximab, adalimumab, ustekinumab, risankizumab, mirikizumab, guselkumab, or upadacitinib over no treatment in adults with moderately to severely active CD; use of certolizumab pegol or vedolizumab is suggested over no treatment. The AGA suggests using higher-efficacy medication rather than lower-efficacy medication (infliximab, adalimumab, vedolizumab, ustekinumab, risankizumab, mirikizumab, or guselkumab versus certolizumab pegol or upadacitinib) for individuals who are naive to advanced therapies. A higher-efficacy medication or intermediate-efficacy medication is suggested rather than a lower-efficacy medication (adalimumab, risankizumab, guselkumab, upadacitinib, ustekinumab, or mirikizumab versus vedolizumab or certolizumab pegol) for individuals who have been exposed to one or more advanced therapies. The AGA suggests against using thiopurine monotherapy for induction of remission in adult outpatients with moderately to severely active CD; thiopurine monotherapy is suggested over no treatment for maintenance of remission, typically induced by corticosteroids. Initial advanced therapy is suggested over step therapy involving corticosteroids and/or immunomodulators.
“Patients should recognize that there are now multiple treatment options available to them, regardless of where they are in their treatment journey,” Scott said in a statement.
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