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Luminal and Fistulizing Crohn’s Disease - Moderate-Severe

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7 Recommendations a Recommendation Statements Strength of Recommendation Certainty of Evidence 8A. In adult outpatients with moderate to severe CD, the AGA suggests the use of corticosteroids over no treatment for induction of remission. Conditional Moderate 8B. In adult outpatients with moderate to severe CD, the AGA recommends against the use of corticosteroids over no treatment for maintenance of remission. Strong Moderate 9. In adult outpatients with moderate to severe CD, the AGA recommends against the use of 5-aminosalicylates or sulfasalazine over no treatment for the induction or maintenance of remission. Strong Moderate 10A. In adult outpatients with CD and active perianal fistula, the AGA recommends the use of infliximab over no treatment for the induction and maintenance of fistula remission. Strong Moderate 10B. In adult outpatients with CD and active perianal fistula, the AGA suggests the use of adalimumab, ustekinumab, or vedolizumab over no treatment for the induction or maintenance of fistula remission. Comment: Evidence suggests certolizumab pegol may not be effective for induction of fistula remission. Conditional Low 10C. In adult outpatients with CD and active perianal fistula without perianal abscess, the AGA suggests against the use of antibiotics alone over no treatment for the induction of fistula remission. Conditional Low 11. In adult outpatients with CD and active perianal fistula without perianal abscess, the AGA recommends the use of biologic agents in combination with an antibiotic over a biologic drug alone for the induction of fistula remission. Strong Moderate a Please see the technical review for the supporting evidence [https://www.gastrojournal.org/article/ S0016-5085(21)00646-6/fulltext]

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