A 32-year-old woman with Crohn's disease has ileocolonic disease, active inflammation, and elevated faecal calprotectin despite 5-ASA therapy. Which therapy has the highest evidence for induction AND maintenance of remission in moderate-to-severe Crohn's disease?

• A Azathioprine monotherapy for induction and maintenance
• B Methotrexate for induction and maintenance
• C Ustekinumab as first-line biologic before anti-TNF agents
• D Anti-TNF therapy (infliximab or adalimumab) for both induction and maintenance ✓

Explanation

Anti-TNF agents (infliximab, adalimumab) are the first-line biologic therapy for moderate-to-severe Crohn's disease and have the strongest evidence base for both induction and maintenance of remission (ACCENT-I, CHARM trials). Azathioprine is effective for maintenance but not as an induction agent. Ustekinumab (UNIFI, IM-UNIFI) has excellent efficacy but is typically positioned after failure of anti-TNF or as first-line in anti-TNF naive patients with safety concerns. Methotrexate is second-line for maintenance.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.