9
Adult outpatients with moderate to severe luminal Crohn's disease
Suggest using biologic agents (with or without immunomodulators)
EARLY, rather than delaying their use until after failure of
5-aminosalicylate and/or corticosteroids (conditional, low)
Thiopurines and
methotrexate
Corticosteroids and
5-aminosalicylate
• Suggest corticosteroids over no treatment for induction of
remission (conditional, moderate)
• Recommend AGAINST the use of corticosteroids over no
treatment for maintenance of remission (strong, moderate)
• Recommend AGAINST the use of 5-aminosalicylate or
sulfasalazine for induction or maintenance of remission
(strong, moderate)
• Suggest AGAINST the use of thiopurine monotherapy over no
treatment for achieving remission (conditional, very low)
• Suggest thiopurine monotherapy or intramuscular
methotrexate monotherapy over no treatment for induction
and maintenance of remission (conditional, moderate)
• Suggest subcutaneous or intramuscular methotrexate
monotherapy over no treatment for induction and
maintenance of remission (conditional, moderate)
• Suggest AGAINST the use of oral methotrexate monotherapy
over no treatment for induction or maintenance of remission
(conditional, very low)
• Recommend biologic monotherapy over thiopurine monotherapy for
induction of remission (strong, moderate)
• In those naïve to biologics and immunomodulators, suggest infliximab
or adalimumab in combination with thiopurine for induction
and maintenance of remission over infliximab or adalimumab
montherapy (conditional, moderate quality for infliximab and very low
quality for adalimumab)
Comment: Based on indirect evidence combination infliximab or
adalimumab with mexotrexate may be more effective than infliximab or
adalimumab monotherapy.
• No recommendation regarding the use of ustekinumab or
vedolizumab in combination with a thiopurine or methotrexate over
biologic drug monotherapy (no recommendation, knowledge gap)
• In quiescent CD on combination therapy, no recommendation for
withdrawal of either immunomodulator or biologic over ongoing
combination therapy of a biologic and an immunomodulator (no
recommendation, knowledge gap)
