A 26-year-old woman with Crohn's disease (ileocolonic, non-stricturing non-penetrating) has failed 5-ASA and azathioprine. Ileocolonoscopy shows deep ulcerations. CRP 42 mg/L, CDAI 340 (severe). She is anti-TNF naïve. Which therapy is recommended as first-line biologic for moderate-to-severe luminal Crohn's disease?
- A Ustekinumab (anti-IL-12/23)
- B Vedolizumab (anti-α4β7 integrin)
- C Tofacitinib (JAK inhibitor)
- D Adalimumab or infliximab (anti-TNF) ✓
Explanation
Anti-TNF agents (infliximab and adalimumab) remain the best-established first-line biologics for moderate-to-severe Crohn's disease with extensive evidence for mucosal healing, fistula closure and steroid-sparing. Combination therapy with an immunomodulator (azathioprine/methotrexate) reduces immunogenicity and is recommended with infliximab (SONIC trial). Ustekinumab (UNIFI/UNIFI-MC) and vedolizumab (GEMINI-2) are approved alternatives with favorable safety profiles but are typically used after anti-TNF failure or in patients with contraindications to anti-TNF. Tofacitinib is approved for UC, not CD.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.