Figure 5
Figure 4
Assess current and prior disease burden
C
Identify patient as low risk
• Age at initial diagnosis >30 years
• Limited anatomic involvement
• No perianal and/or severe rectal
disease
• Superficial ulcers
• No prior surgical resection
• No stricturing and/or penetrating
behavior
Identify patient as moderate/
high risk
• Age at initial diagnosis <30
years
• Extensive anatomic involvement
• Perianal and/or severe rectal
disease
• Deep ulcers
• Prior surgical resection
• Stricturing and/or penetrating
behavior
Perform initial treatment
Ileum and/or proximal colon — none
to minimal systemic symptoms
Options:
• Budesonide 9 mg per day with or
without AZA
• Tapering course of prednisone with
or without AZA
Moderately severe Crohn's
Options:
• Use anti-TNF monotherapy
over no therapy or thiopurine
monotherapy
• Use anti-TNF + thiopurine over
thiopurine monotherapy or anti-
TNF monotherapy
• Use methotrexate for patients
who do not tolerate purine
analog in combination with
anti-TNF
Low-risk patient
D
Mod/high-risk patient
c
E
Diffuse or left colon —
none/minimal systemic symptoms
Options:
• Tapering course of prednisone with
or without AZA
c
Combination therapy with
immunosuppressant and anti-TNF biologic
offers improved efficacy and durability
compared with anti-TNF monotherapy and
should be considered for mod/high-risk
patients requiring 2
nd
or 3
rd
biologic.
Disease
