A 30-year-old woman with Crohn's disease (ileocolonic, inflammatory phenotype, CRP 45, faecal calprotectin 1200 μg/g) has failed azathioprine. She is steroid-dependent. Which biologic therapy is preferred as first-line in this setting?
- A Vedolizumab as preferred first biologic in all Crohn's
- B Anti-TNF therapy (infliximab or adalimumab) ✓
- C Ustekinumab before any anti-TNF therapy
- D Tofacitinib as first JAK inhibitor for Crohn's
Explanation
Anti-TNF agents (infliximab, adalimumab) remain the most commonly recommended first biologic for moderate-to-severe Crohn's disease after conventional therapy failure, with the largest evidence base for induction and maintenance of remission including mucosal healing. Vedolizumab (gut-selective integrin inhibitor) is preferred in some guidelines for UC over Crohn's as first biologic due to slower onset. Ustekinumab (IL-12/23 inhibitor) is a valid alternative but typically used in anti-TNF naïve or failed patients. Tofacitinib is not approved for Crohn's disease (approved for UC only).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.