Selecting CD Treatment in Special Scenarios


Experts in gastroenterology discuss treatment selection in special situations of CD, such as age, women considering pregnancy, and extra-intestinal manifestations.

This is a video synopsis/summary of a panel discussion involving Marla Dubinsky, MD; David Rubin, MD; Miguel Regueiro, MD; Remo Panaccione, MD, FRCPC; and Sara Horst, MD, MPH.

The discussion revolves around advanced therapies for Crohn's disease, focusing on specific scenarios and the choice of treatments. The participants discuss their preferences based on various patient characteristics and conditions.

The conversation begins with considerations for patients previously exposed to anti-TNF (tumor necrosis factor) therapies. Natalizumab is deemed less effective in this population, and risankizumab is suggested as a preferable option over upadacitinib due to similar data outcomes. The need for speed in specific cases, such as those with extra-intestinal manifestations, is highlighted, making upadacitinib an attractive choice.

The panel discusses the importance of personalized medicine, considering factors like inflammatory joint problems, spondyloarthropathy, or other manifestations. Choices are tailored to individual patient profiles, with IL (interleukin)-23-based strategies favored for certain scenarios.

Pregnant women are advised on the importance of disease control, with emphasis on the safety of IL-23 and IL-12/23, alongside traditional anti-TNF options. The potential use of JAK (Janus kinase) inhibitors for quick induction of deeper remission is acknowledged.

The safety profile of JAK inhibitors is addressed, dispelling misconceptions and encouraging broader utilization in IBD (inflammatory bowel disease) management. The discussion concludes with a rapid-fire round where each participant shares their first-line therapy preferences for specific patient scenarios.

In closing, the participants express hope for the future of Crohn's disease management, emphasizing the evolving landscape of precision medicine, advancements in fibrosis treatment, the paradigm shift in disease monitoring, and the promise of combination therapies. The concept of treating Crohn's disease earlier in its course is highlighted as a future goal, providing optimism for improved patient outcomes.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

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