GA recommends early use of biologics in patients with moderate-to-severe Crohn’s disease
Crohn’s disease, a type of inflammatory bowel disease (IBD) that causes
inflammation (pain and swelling) in the gastrointestinal tract, can cause daily
health problems, frequent hospitalizations and surgery when not adequately
controlled. While there is no cure for Crohn’s disease, there are treatments
that can help patients live a symptom-free life.
After a detailed review of available literature, the American
Gastroenterological Association (AGA) has released new clinical guidelines outlining
the benefits and risks of each drug currently available to Crohn’s patients.
Based on this research, AGA recommends the early introduction of biologics for
patients experiencing luminal and fistulizing Crohn’s disease rather than
waiting until other treatments fail. These guidelines are published in Gastroenterology,
AGA’s official journal.
“With many new drugs entering the market, clinician’s ability to
treat patients with Crohn’s disease has improved greatly over the last 20
years,” said lead author Joseph D. Feuerstein, MD, from Beth Israel
Deaconess, Boston, Massachusetts. “We hope this new guideline serves as a
manual for clinicians in selecting the right therapies for their patients,
which should lead to improved patient outcomes and less need for invasive
Key guideline recommendations:
1. Biologics are
the most effective drugs for the management of Crohn’s and they should be used
early, rather than delaying their use until after failure of mesalamine and/or
corticosteroids, in patients with moderate to severe or fistulizing Crohn’s
disease. These drugs are antibodies and can more precisely target the immune
system which is causing the inflammation in Crohn’s disease.
necrosis factor (anti-TNF) agents or ustekinumab are recommended and
vedolizumab is suggested as a first-line treatment.
b. In patients who
have previously not responded to anti-TNF agents, AGA recommends ustekinumab or
c. The biologic
natalizumab is no longer recommended due to potential adverse events and the
availability of safer treatment options.
- Joseph D.
Feuerstein, Edith Y. Ho, Eugenia Shmidt, Harminder Singh, Yngve Falck-Ytter,
Shanaz Sultan, Jonathan P. Terdiman, Shahnaz Sultan, Benjamin L. Cohen, Karen
Chachu, Lukejohn Day, Perica Davitkov, Benjamin Lebwohl, Theodore R. Levin,
Amit Patel, Anne F. Peery, Raj Shah, Harminder Singh, Siddharth Singh, Stuart
J. Spechler, Kyle Staller, Aaron P. Thrift, Jennifer M. Weiss. AGA
Clinical Practice Guidelines on the Medical Management of Moderate to
Severe Luminal and Perianal Fistulizing Crohn’s Disease. Gastroenterology,
2021; 160 (7): 2496 DOI: 10.1053/j.gastro.2021.04.022