In clinical practice guidelines from the American Gastroenterological Association (AGA) published in the June 1 issue of Gastroenterology, recommendations are presented for the management of moderate-to-severe luminal and fistulizing Crohn disease (CD) in adult outpatients.
Joseph D. Feuerstein, M.D., from Beth Israel Deaconess Medical Center in Boston and colleagues presented recommendations from the AGA for the medical management of moderate-to-severe luminal and fistulizing CD in adult outpatients.
The authors recommend use of anti-tumor necrosis factor α (TNFα) over no treatment for induction and maintenance of remission in adult outpatients with moderate-to-severe CD. In addition, vedolizumab is suggested over no treatment and ustekinumab is recommended over no treatment. The AGA recommends against natalizumab over no treatment for induction and maintenance of remission. Infliximab, adalimumab, or ustekinumab are recommended over certolizumab pegol, and vedolizumab is suggested over certolizumab pegol for induction of remission in adult outpatients with moderate-to-severe CD who are naive to biologic drugs. Use of ustekinumab is recommended and vedolizumab is suggested over no treatment for remission induction in adult outpatients with moderate-to-severe CD who never responded to anti-TNFα.
“With many new drugs entering the market, clinician’s ability to treat patients with Crohn’s disease has improved greatly over the last 20 years,” Feuerstein said in a statement. “We hope this new guideline serves as a manual for clinicians in selecting the right therapies for their patients, which should lead to improved patient outcomes and less need for invasive surgery.”
Several authors disclosed ties to the pharmaceutical industry.