When is it appropriate to use concomitant immunomodulators with anti-TNF agents for the treatment of Crohn’s disease?

Below you can input patient characteristics and see the BRIDGe RAND panel’s recommendations for the use of monotherapy versus combination therapy for the treatment of Crohn’s disease. Assuming that ALL patients will receive an anti-TNF agent, the output will be the appropriateness of also using an immunomodulator.

Patient type

Patients were categorized into five different scenarios. Please choose the scenario that best fits the patient in question:

Patient type: *

No previous exposure to steroids, immunomodulators, or biologic therapy

Induction therapy with steroids alone; no concurrent or previous exposure to immunomodulator or biologic

Currently on an immunomodulator at treatment doses for at least 2 months, but still with active disease

Clinical attenuation or intolerance to monotherapy with 1 anti-TNF

Patients on concomitant immunomodulator (at any dose) and biologic for at least 6 months

Disease variables

Now, please select the disease variables that best describes the patient in question:

Disease extent: *

Limited to ileum and right colon, no more than 15 cm ileal involvement

More than 15 cm ileal involvement and/or upper tract/mid-small bowel involvement and/or more than right-sided colonic involvement

Perianal involvement: *

No fissure, fistula, or anal stricture (ever)

Active or previous fissure, fistula, or anal stricture

Age: *

Age 25 years or younger

Age 26 or older

Gender: *

Female

Male

Disease duration: *

Disease duration of 2 years or less (since diagnosis)

Disease duration of greater than 2 years (since diagnosis)

Surgery history: *

No previous intestinal resection

1 limited (<15 cm ileal or ileo-cecal) resection

1 extensive (>15 cm ileal) resection, or more than 1 resection