Curbside Consultation in IBD: 49 Clinical Questions, Second Edition

David T Rubin, MD; Sonia Friedman, MD; Francis A Farraye, MD MSc

Question 18: Which Patients Might Be Better For A “Top-Down” Approach (Using Anti-Tumor Necrosis Factor Therapy Before Steroids Or Proven Failure Of Oral Thiopurines)? Which Patients Should Be Started On Dual Therapy (Immunomodulator And Anti-Tumor Necrosis Factor)? (continued)

Sonia Friedman, MD

Crohn’s disease (CD) is a chronic, progressive, destructive disease that can lead to the development of complications such as strictures, fistulas, and abscesses over time. The traditional “step-up” treatment algorithm of initial steroids gradually followed by immunosuppressives and then anti-tumor necrosis factor (TNF) agents as the CD becomes more severe does not alter the natural history of the disease. However, early treatment with anti-TNF agents can modify the course of CD by reducing surgery and hospitalization rates and giving patients a better quality of life…