5
Recommendations
a
Recommendation Statements
Strength of
Recommendation
Certainty
of Evidence
2B. In adult outpatients with moderate to
severe CD who never responded to anti-
TNFα (primary nonresponse), the AGA
recommends the use of ustekinumab and
suggests the use of vedolizumab over no
treatment for the induction of remission.
Strong
Conditional
Moderate
Low
2C. In adult outpatients with moderate to
severe CD who previously responded to
infliximab (secondary nonresponse), the
AGA recommends the use of adalimumab
or ustekinumab and suggests the use of
vedolizumab over no treatment for the
induction of remission.
Comment: If adalimumab was the first-line
drug used there is indirect evidence to suggest
the option of using infliximab as a second-line
agent.
Strong
Conditional
Moderate
Low
3A. In adult outpatients with moderate to severe
CD, the AGA suggests against the use of
thiopurines over no treatment for achieving
remission.
Conditional Very Low
3B. In adult outpatients with quiescent moderate
to severe CD (or patients in corticosteroid-
induced remission), the AGA suggests the
use of thiopurines over no treatment for the
maintenance of remission.
Conditional Low
3C. In adult outpatients with moderate to
severe CD, the AGA suggests the use of
subcutaneous or intramuscular methotrexate
monotherapy over no treatment for the
induction and maintenance of remission.
Conditional Moderate
3D. In adult outpatients with moderate to severe
CD, the AGA suggests against the use of
oral methotrexate monotherapy over no
treatment for the induction and maintenance
of remission.
Conditional Very low
4. In adult outpatients with moderate to severe
CD, the AGA recommends the use of
biologic drug monotherapy over thiopurine
monotherapy for the induction of remission.
Strong Moderate
