Last, what are living guidelines? 🧑‍🍼

🔹 With how quick drug-development 💊 and treatment strategies ♟️ change, AGA will review new lit. 📄 and update recommendations 📝 as needed every 6 months.
Stay tuned for updates in the future!

9/9

✳️11-12 . For TNF + IMM therapy, when should you stop?

❌ stop TNF if combo therapy

🤷‍♂️ Knowledge gap: no recommendation on continuing IMM or when to stop 🗓️

✳️13. For patients w/ mod-severe disease:
👍 Early advanced therapy
❌ No step-up 🪜 therapy

✳️14 If now on advanced 💊, stop 5-ASAs

8/9

✳️8, ✳️9, ✳️10 Combo therapy 💊+💊

🔹 TNF + immunomodulator > TNF or IMM alone

🤷‍♂️Knowledge gap: no recommendation about whether IMM + non-TNF biologic is helpful

7/9

✳️5, ✳️6, ✳️7. Immunomodulators 💊

❌ Thiopurines for induction

👍 Okay to use thiopurines for maintenance

❌ Methotrexate for induction or maintenance

6/9

❗️Important Points❗️

❗️High🪣or med🪣 are recommended over lower🪣, but high🪣 is not necessarily > med 🪣

❗️Factor in pt attributes when making tx choices, not just focusing efficacy buckets:

👨‍🦳age
🤰pregnancy status
🤒comorbidities
👩‍🦽functional status
🔅patient preferences

5/9

What about comparative efficacy for bio-naïve & bio-exposed?

✳️3. Bionaïve💉💊

High🪣: IFX, VDZ, OZA, ETR, UPA, RISA, GUS

Med🪣: GOL, UST, TOFA, FIL, MIRI

Lower🪣: ADA

✳️4. Exposed💉💊

High🪣: TOFA, UPA, UST

Med🪣: FIL, MIRI, RISA, GOL

Low🪣: ADA, VDZ, OZA, ETR

4/9

✳️1 & ✳️2: What is efficacy of 💊 compared to placebo for all-comers?

High🪣: IFX, GOL, VDZ, TOFA, UPA, UST, OZA, ETR, RISA, GUS

Med 🪣: ADA, FIL, MIRI

Caveats 🔦
1. JAKis often 🙅‍♂️ for 1st line use per FDA
2. Biosimilar= originator
3. SC = IV

3/9

But first, details 🤓

📍Developed using GRADE framework

📍Thresholds for clinically meaningful benefits across all 💊: >10% vs. pbo & >5% vs. other 💊

📍Provides guidance by stratifying of meds into 🪣s: high-, intermediate-, and lower-efficacy, for biologic-naïve and -exposed patients

2/9