Figure 5
Short course of steroids
with initiation of
thiopurine
Options:
• Thiopurine and taper steroids
over 60 days
• Anti-TNF, with or without
thiopurine
• Vedolizumab, with or without
thiopurine or methotrexate
Remission
Anti-TNF, with or
without thiopurine
a,b
Vedolizumab,
with or without
immunomodulator
c
Continue anti-TNF,
with or without thiopurine
Continue vedolizumab, with or
without immunomodulator
Maintenance Therapy Inductive Therapy
No Remission Relapse
Therapy for High-Risk
Outpatient Not in
Remission
Therapy for High-Risk
Outpatient Not in
Remission
6
6
Inductive and Maintenance Therapy
(High Risk, Outpatient)
5
Figure 5 and 6 Footnotes
a
Combination therapy with a thiopurine is more efficacious than anti-TNF monotherapy and
should be considered, especially in patients who have failed one or more anti-TNF agents.
b
Extrapolating from data in Crohn's disease, methotrexate may be used instead of thiopurines to
decrease anti-TNF immunogenicity.
c
Extrapolating from data with anti-TNF agents, thiopurines and methotrexate may be used to
decrease vedolizumab immunogenicity.
d
e addition of allopurinol (while decreasing the thiopurine dose to 1/4 of the previous dose)
may be considered at centers with experience with this approach and recognizing the risks of
severe myelosuppression and infection.
Remission
Remission
Colitis
