Treatment
6
Recommendations
a
Recommendation Statements
Strength of
Recommendation
Certainty
of Evidence
5A. In adult outpatients with moderate to
severe CD who are naïve to biologics and
immunomodulators, the AGA suggests
the use of infliximab in combination
with thiopurines for the induction and
maintenance of remission over infliximab
monotherapy.
Comment: Based on indirect evidence,
combination infliximab with methotrexate
may be more effective over infliximab
monotherapy.
Conditional Moderate
5B. In adult outpatients with moderate to
severe CD who are naïve to biologics and
immunomodulators, the AGA suggests
the use of adalimumab in combination
with thiopurines for the induction and
maintenance of remission over adalimumab
monotherapy.
Comment: Based on indirect evidence,
combination adalimumab with methotrexate
may be more effective over adalimumab
monotherapy.
Conditional Very low
5C. In adult outpatients with moderate to severe
CD, the AGA makes no recommendation
regarding the use of, ustekinumab or
vedolizumab in combination with
thiopurines or methotrexate over biologic
drug monotherapy for the induction and
maintenance of remission.
No
recommendation
Knowledge
gap
6. In adult outpatients with quiescent CD on
combination therapy, the AGA makes no
recommendation for withdrawal of either
the immunomodulator or the biologic over
ongoing combination therapy of a biologic
and an immunomodulator
No
recommendation
Knowledge
gap
7. In adult outpatients with moderate to severe
CD, the AGA suggests early introduction
with a biologic with or without an
immunomodulator rather than delaying their
use until aer failure of 5-aminosalicylates
and/or corticosteroids.
Conditional Low
