Treatment
4
Recommendations
a
Recommendation Statements
Strength of
Recommendation
Certainty
of Evidence
1A. In adult outpatients with moderate to severe
CD, the AGA recommends the use of anti-
TNFα over no treatment for induction and
maintenance of remission.
Comment: Although the evidence
supporting infliximab and adalimumab
was moderate certainty, the evidence for
certolizumab pegol was low certainty.
Strong Moderate
1B. In adult outpatients with moderate to
severe CD, the AGA suggests the use of
vedolizumab over no treatment for the
induction and maintenance of remission.
Conditional Low for
induction,
moderate for
maintenance
1C. In adult outpatients with moderate to
severe CD, the AGA recommends the use
of ustekinumab over no treatment for the
induction and maintenance of remission.
Strong Moderate
1D. In adult outpatients with moderate to severe
CD, the AGA suggests against the use
of natalizumab over no treatment for the
induction and maintenance of remission.
Comment: Given evidence of harm in
post marketing data from progressive
multifocal leukoencephalopathy (PML)
and the availability of other drugs, the AGA
suggests against the use of natalizumab.
Patients who are John Cunningham virus
antibody–negative who put a high value on
the potential benefits and lower value on
PML risk and who will adhere to ongoing
monitoring for John Cunningham virus
positivity, may consider using natalizumab.
Conditional Moderate
2A. In adult outpatients with moderate to
severe CD who are naïve to biologic
drugs, the AGA recommends the use of
infliximab, adalimumab, or ustekinumab
over certolizumab pegol for the induction
of remission and suggests the use of
vedolizumab over certolizumab pegol for the
induction of remission.
Strong
Conditional
Moderate
Low
