🗒️2024 ECCO Guidelines on Therapeutics in Crohn’s Disease: Medical Treatment 💊
@Y_ECCO_IBD
#IBD #MedEd #GITwitter #MedTwitter
1️⃣4️⃣ Statements and 6️⃣Practice points
1️⃣ 5-ASA is not recommended🚫for the induction or maintenance therapy in CD➡️consistent lack of evidence.
🧵👇
@Y_ECCO_IBD
#IBD #MedEd #GITwitter #MedTwitter
1️⃣4️⃣ Statements and 6️⃣Practice points
1️⃣ 5-ASA is not recommended🚫for the induction or maintenance therapy in CD➡️consistent lack of evidence.
🧵👇
@Y_ECCO_IBD 2️⃣ Budesonide💊 is recommended for inducing clinical remission in patients with active, mild-to-moderate CD limited to the ileum / ascending colon🎯
👉Additionally, systemic corticosteroids are suggested for induction therapy in patients with active, moderate-to-severe CD💉
👉Additionally, systemic corticosteroids are suggested for induction therapy in patients with active, moderate-to-severe CD💉
@Y_ECCO_IBD 3️⃣Thiopurine monotherapy💊 is not🚫 recommended for induction therapy in CD, but it can be considered for maintenance 👌
4️⃣Parenteral 💉methotrexate is suggested for both induction and maintenance therapy in moderate-to-severe CD
4️⃣Parenteral 💉methotrexate is suggested for both induction and maintenance therapy in moderate-to-severe CD
@Y_ECCO_IBD 5️⃣ Infliximab➡️induction and maintenance for mod/sev active CD
👉Use combination with thiopurine during the induction and continue 6–12 months
Patients who achieve long-term remission🌈 with this combination ➡️de-escalation to infliximab monotherapy and withdrawal of thiopurines
👉Use combination with thiopurine during the induction and continue 6–12 months
Patients who achieve long-term remission🌈 with this combination ➡️de-escalation to infliximab monotherapy and withdrawal of thiopurines
@Y_ECCO_IBD 6️⃣ Adalimumab 💉is recommended as both induction and maintenance therapy for patients with moderate-to-severe CD
👉For those bionaïve, Adalimumab monotherapy 💪is preferred over combination therapy with thiopurines during induction and maintenance.
👉For those bionaïve, Adalimumab monotherapy 💪is preferred over combination therapy with thiopurines during induction and maintenance.
@Y_ECCO_IBD 7️⃣Certolizumab💉 is suggested for both induction and maintenance therapy in moderate-to-severe CD.
🎱 There is insufficient evidence📋 to recommend proactive therapeutic drug monitoring over reactive monitoring or standard care for anti-TNF agents 🤔
🔥Controversy here!
🎱 There is insufficient evidence📋 to recommend proactive therapeutic drug monitoring over reactive monitoring or standard care for anti-TNF agents 🤔
🔥Controversy here!
@Y_ECCO_IBD 9️⃣Ustekinumab is recommended 👍for both induction and maintenance therapy in moderate-to-severe CD
🔟Adalimumab and ustekinumab 🆚 are suggested to be equally effective🟰 for both induction and maintenance therapy in biologic-naïve patients with moderate-to-severe CD
🔟Adalimumab and ustekinumab 🆚 are suggested to be equally effective🟰 for both induction and maintenance therapy in biologic-naïve patients with moderate-to-severe CD
@Y_ECCO_IBD 1️⃣1️⃣ 1️⃣2️⃣&1️⃣3️⃣ Risankizumab, vedolizumab, and upadacitinib are all recommended for both induct/maint therapy in mod-sev CD
1️⃣4️⃣Exclusive enteral nutrition 👉 induction option for patients with mild-mod CD who prefer to avoid corticosteroids and have access to dietetic support
1️⃣4️⃣Exclusive enteral nutrition 👉 induction option for patients with mild-mod CD who prefer to avoid corticosteroids and have access to dietetic support
@Y_ECCO_IBD 🔴Practice Points
1️⃣ Therapeutic drug monitoring 📈 may be used when optimising dose 💉in patients with CD treated with anti-TNF therapy.
1️⃣ Therapeutic drug monitoring 📈 may be used when optimising dose 💉in patients with CD treated with anti-TNF therapy.
@Y_ECCO_IBD 2️⃣Dietary therapies 🍱 may help reduce inflammation in CD, though no universal diet works for all❌🌍
All CD patients should have access to dietary services🥼
💭Interventions based on disease activity and patient needs
👉Consider partial enteral nutrition for some in remission
All CD patients should have access to dietary services🥼
💭Interventions based on disease activity and patient needs
👉Consider partial enteral nutrition for some in remission
@Y_ECCO_IBD 3️⃣There isn’t enough evidence to determine the best way to use advanced therapies for luminal CD 🤷♂️
When making decisions, factors like efficacy 💪, safety 🛡️, patient preferences and characteristics, disease characteristics, and cost or access to therapies should be considered
When making decisions, factors like efficacy 💪, safety 🛡️, patient preferences and characteristics, disease characteristics, and cost or access to therapies should be considered
@Y_ECCO_IBD 4️⃣Advanced combination💊💉 therapy might be needed for refractory CD, extraintestinal manifestations or immune-mediated disorders that require more than one agent to achieve remission
👉No evidence to support using advanced combination therapy in bio-naive patients✋
👉No evidence to support using advanced combination therapy in bio-naive patients✋
@Y_ECCO_IBD 5️⃣ It is recommended to involve a multidisciplinary team (MDT) 👥👥in the clinical management and joint decision-making for patients with CD
6️⃣ A tight control🔍 and treat-to-target approach is recommended for managing patients with CD
6️⃣ A tight control🔍 and treat-to-target approach is recommended for managing patients with CD
@Y_ECCO_IBD Excellent work by the authors
#HannahGordon @UriKopylov @bverstockt @maria_chs @IBD_MB @jp_gisbert @BettenworthDb @RajaAtreya @BattatMD4IBD @Jolinedegroof @TakuKobayashiM1
@geteccu
Full text link👇
academic.oup.com
#HannahGordon @UriKopylov @bverstockt @maria_chs @IBD_MB @jp_gisbert @BettenworthDb @RajaAtreya @BattatMD4IBD @Jolinedegroof @TakuKobayashiM1
@geteccu
Full text link👇
academic.oup.com
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