A 28-year-old man with Crohn's disease presents with a perianal fistula and proctoscopy shows no active rectal disease. He has had 2 prior infliximab infusions but developed anti-drug antibodies. Which biologic is MOST appropriate to switch to?

• A Vedolizumab (anti-α4β7 integrin)
• B A different anti-TNF agent (adalimumab) as second anti-TNF
• C Tofacitinib (JAK inhibitor)
• D Ustekinumab (anti-IL-12/23) ✓

Explanation

When a patient loses response to infliximab due to immunogenicity (anti-drug antibodies), switching within the anti-TNF class (to adalimumab) has lower efficacy than switching to a different mechanism. Ustekinumab (anti-IL-12/23 p40 subunit) is approved for moderately-to-severely active Crohn's disease and is effective in anti-TNF failures, as demonstrated in the IM-UNITI trial. Vedolizumab is more effective for UC than CD for perianal disease specifically. Tofacitinib is not approved for Crohn's disease.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.