The American Gastroenterological Association published new guidelines on the use of Thiopurines, Methotrexate, and anti–TNF biologic drugs for the induction and maintenance of remission in Crohn’s Disease. Selecting among immunomodulator monotherapy, anti-TNF-alpha monotherapy and combination therapy is a clinical dilemma. The AGA decision support tool (gastro.org/crohnsdecisiontool) and guidelines on the use of immunomodulators and anti-TNF-alpha biologic agents in inducing and maintaining clinical remission in patients with inflammatory (luminal) Crohn’s disease is of considerable value. The technical review is also available for review, which offers an in-depth analysis of the existing research informing the clinical recommendations.

Recommendations for the induction of remission:

1. The AGA suggests against using thiopurine monotherapy to induce remission in patients with moderately severe Crohn’s disease.

2. The AGA suggests against using methotrexate to induce remission in patients with moderately severe Crohn’s disease.

3. The AGA recommends using anti-TNF-alpha drugs to induce remission in patients with moderately severe Crohn’s disease.

4. The AGA recommends using anti-TNF-alpha monotherapy over thiopurine monotherapy to induce remission in patients who have moderately severe Crohn’s disease.

5. The AGA recommends using anti-TNF-alpha drugs in combination with thiopurines over thiopurine monotherapy to induce remission in patients who have moderately severe Crohn’s disease.

6. The AGA suggests using anti-TNF-alpha drugs in combination with thiopurines over anti-TNF-alpha drug monotherapy to induce remission in patients who have moderately severe Crohn’s disease.

Recommendations for maintenance of remission:

1. The AGA recommends using thiopurines over no immunomodulator therapy to maintain a steroid-induced remission in patients with Crohn’s disease.

2. The AGA suggests using methotrexate over no immunomodulator therapy to maintain a steroid-induced remission in patients with Crohn’s disease.

3. The AGA suggests using anti-TNF-alpha drugs over no anti-TNF-alpha drugs to maintain a steroid or anti-TNF-alpha drug-induced remission in patients with Crohn’s disease.

4. The AGA makes no recommendation for or against the combination of an anti-TNF-alpha drug and a thiopurine versus an anti-TNF-alpha drug alone to maintain remission induced by a combination of these drugs in patients with Crohn’s disease.

http://download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS0016508513015217.pdf

http://download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS0016508513015205.pdf