New Guideline for Treatment of Crohn Disease

Target Population: Gastroenterologists

Background and Objective

Recent evidence from randomized, controlled trials has refined our understanding of the best use of immunomodulators (thiopurines and methotrexate) and anti–tumor necrosis factor (TNF)–α agents in moderate-to-severe Crohn disease. The AGA has synthesized these findings into a new guideline, divided into recommendations for induction of remission and maintenance of remission.

Key Recommendations

For induction of remission:

• Thiopurines and methotrexate are no longer recommended as primary therapies. Instead, patients can be treated with steroids or anti–TNF-α agents as primary therapy.

• When treating patients with steroids, consider the addition of an immunomodulator (thiopurine or methotrexate) to maintain remission and obtain a corticosteroid-sparing effect.

• When treating patients with anti–TNF-α agents, consider use of a thiopurine also.

For maintenance of remission:

• If steroids were used for induction, then use an immunomodulator or an anti–TNF-α agent with or without a thiopurine.

• If an anti–TNF-α agent was used for induction, then use an anti–TNF-α agent with or without a thiopurine.