Overview
- The AGA published a living guideline in Gastroenterology on Nov. 20 with 16 recommendations derived from network meta-analyses of 11 medications, with semiannual evidence reviews planned.
- The guidance shifts practice toward initiating higher‑efficacy advanced therapies early rather than using step‑up care with corticosteroids or immunomodulators.
- Recommended options include infliximab, adalimumab, ustekinumab, risankizumab, mirikizumab, guselkumab, or upadacitinib, with certolizumab pegol or vedolizumab suggested in some scenarios.
- Treatment pathways differ by prior exposure to advanced therapy, with higher‑ or intermediate‑efficacy agents preferred over lower‑efficacy alternatives for previously treated patients.
- Thiopurine monotherapy is discouraged for inducing remission, with use limited to maintaining steroid‑induced remission when no advanced options are available, and the authors urge payers to align coverage and will host a Dec. 18 webinar to discuss the recommendations.