Moderate-to-Severely Active Crohn's Disease Previously Exposed to Advanced Therapies

This protocol applies to adults with moderate-to-severely active Crohn's disease who have already received one or more advanced therapies — in particular TNF antagonists — and need a structured approach to regain and sustain disease control.

Clinical Scenario

The patient presents with moderate-to-severely active Crohn's disease and has prior exposure to one or more advanced therapies, with TNF antagonists being of particular clinical relevance to treatment selection.

Moderate-to-severe activity Prior advanced therapy TNF antagonist exposure

Treatment Goal

The primary objective is induction and maintenance of clinical remission, defined as a Crohn's Disease Activity Index (CDAI) below 150.

Approach — Partial Overview

In this population, current evidence supports selecting a higher- or intermediate-efficacy advanced therapy over lower-efficacy alternatives. The full protocol specifies which options are recommended and how they compare…

Full therapy selection and sequencing are available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

In adult outpatients with moderate-to-severely active CD who have previously been exposed to 1 or more advanced therapies, particularly TNF antagonists, the AGA suggests using a HIGHER efficacy medication (adalimumab, risankizumab, guselkumab, upadacitinib) OR an INTERMEDIATE efficacy medication (ustekinumab, mirikizumab), rather than a LOWER efficacy medication (vedolizumab, certolizumab pegol).

CDAI scores <150 suggest clinical remission, and scores 150–220, 221–450, and >450 denote mild, moderate, and severe disease, respectively.

View source ↗