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First-Line Biologics or Small Molecules in Inflammatory Bowel Disease: a Practical Guide for the Clinician

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Purpose of Review

Treating moderate-to-severe inflammatory bowel disease has become increasingly complex as the array of available biologics increases. Moreover, tofacitinib, the first small molecule approved for IBD, is available for use in ulcerative colitis. Choosing the right biologic, for the right patient, at the right time, can be a confusing and daunting task for clinicians.

Recent Findings

In this review, we summarize the evidence for first-line use of the available biologics by disease state. Special circumstances for consideration including rapidity of action, safety, comparative effectiveness, postoperative Crohn’s disease, fertility and pregnancy, and extraintestinal manifestations are discussed.


In the moderate-to-severe UC patient, vedolizumab and infliximab are preferred first-line options. In the moderate-to-severe CD patient with a penetrating phenotype or with multiple EIMs, infliximab or adalimumab are the preferred first-line agents. In the moderate-to-severe CD patient with an inflammatory phenotype, anti-TNF, vedolizumab, and ustekinumab are all reasonable options.

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Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.

    Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359(9317):1541–9. https://doi.org/10.1016/S0140-6736(02)08512-4.

  2. 2.

    Hanauer SB, Sandborn WJ, Rutgeerts P, Fedorak RN, Lukas M, MacIntosh D, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130(2):323–33; quiz 591. https://doi.org/10.1053/j.gastro.2005.11.030.

  3. 3.

    Colombel JF, Sandborn WJ, Rutgeerts P, Enns R, Hanauer SB, Panaccione R, et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology. 2007;132(1):52–65. https://doi.org/10.1053/j.gastro.2006.11.041.

  4. 4.

    Sandborn WJ, Hanauer SB, Rutgeerts P, Fedorak RN, Lukas M, MacIntosh DG, et al. Adalimumab for maintenance treatment of Crohn’s disease: results of the CLASSIC II trial. Gut. 2007;56(9):1232–9. https://doi.org/10.1136/gut.2006.106781.

  5. 5.

    Sandborn WJ, Feagan BG, Stoinov S, Honiball PJ, Rutgeerts P, Mason D, et al. Certolizumab pegol for the treatment of Crohn’s disease. N Engl J Med. 2007;357(3):228–38. https://doi.org/10.1056/NEJMoa067594.

  6. 6.

    Schreiber S, Khaliq-Kareemi M, Lawrance IC, Thomsen OO, Hanauer SB, McColm J, et al. Maintenance therapy with certolizumab pegol for Crohn’s disease. N Engl J Med. 2007;357(3):239–50. https://doi.org/10.1056/NEJMoa062897.

  7. 7.

    Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med. 1999;340(18):1398–405. https://doi.org/10.1056/NEJM199905063401804.

  8. 8.

    Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353(23):2462–76. https://doi.org/10.1056/NEJMoa050516.

  9. 9.

    Reinisch W, Sandborn WJ, Hommes DW, D’Haens G, Hanauer S, Schreiber S, et al. Adalimumab for induction of clinical remission in moderately to severely active ulcerative colitis: results of a randomised controlled trial. Gut. 2011;60(6):780–7. https://doi.org/10.1136/gut.2010.221127.

  10. 10.

    Sandborn WJ, Feagan BG, Marano C, Zhang H, Strauss R, Johanns J, et al. Subcutaneous golimumab induces clinical response and remission in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2014;146(1):85–95; quiz e14–5. https://doi.org/10.1053/j.gastro.2013.05.048.

  11. 11.

    Sandborn WJ, Feagan BG, Marano C, Zhang H, Strauss R, Johanns J, et al. Subcutaneous golimumab maintains clinical response in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2014;146(1):96–109 e1. https://doi.org/10.1053/j.gastro.2013.06.010.

  12. 12.

    Sands BE, Blank MA, Patel K, van Deventer SJ, Study AI. Long-term treatment of rectovaginal fistulas in Crohn’s disease: response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol. 2004;2(10):912–20.

  13. 13.

    Berg DR, Colombel JF, Ungaro R. The role of early biologic therapy in inflammatory bowel disease. Inflamm Bowel Dis. 2019. https://doi.org/10.1093/ibd/izz059.

  14. 14.

    Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362(15):1383–95. https://doi.org/10.1056/NEJMoa0904492.

  15. 15.

    Papamichael K, Vogelzang EH, Lambert J, Wolbink G, Cheifetz AS. Therapeutic drug monitoring with biologic agents in immune mediated inflammatory diseases. Expert Rev Clin Immunol. 2019;15(8):837–48. https://doi.org/10.1080/1744666X.2019.1630273.

  16. 16.

    Sandborn WJ, Feagan BG, Rutgeerts P, Hanauer S, Colombel JF, Sands BE, et al. Vedolizumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2013;369(8):711–21. https://doi.org/10.1056/NEJMoa1215739.

  17. 17.

    Feagan BG, Rutgeerts P, Sands BE, Hanauer S, Colombel JF, Sandborn WJ, et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013;369(8):699–710. https://doi.org/10.1056/NEJMoa1215734.

  18. 18.

    Mosli MH, MacDonald JK, Bickston SJ, Behm BW, Tsoulis DJ, Cheng J, et al. Vedolizumab for induction and maintenance of remission in ulcerative colitis: a Cochrane systematic review and meta-analysis. Inflamm Bowel Dis. 2015;21(5):1151–9. https://doi.org/10.1097/MIB.0000000000000396.

  19. 19.

    Engel T, Ungar B, Yung DE, Ben-Horin S, Eliakim R, Kopylov U. Vedolizumab in IBD-lessons from real-world experience; a systematic review and pooled analysis. J Crohns Colitis. 2018;12(2):245–57. https://doi.org/10.1093/ecco-jcc/jjx143.

  20. 20.

    Amiot A, Grimaud JC, Peyrin-Biroulet L, Filippi J, Pariente B, Roblin X, et al. Effectiveness and safety of vedolizumab induction therapy for patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2016;14(11):1593–601 e2. https://doi.org/10.1016/j.cgh.2016.02.016.

  21. 21.

    Vivio EE, Kanuri N, Gilbertsen JJ, Monroe K, Dey N, Chen CH, et al. Vedolizumab effectiveness and safety over the first year of use in an IBD clinical practice. J Crohns Colitis. 2016;10(4):402–9. https://doi.org/10.1093/ecco-jcc/jjv226.

  22. 22.

    Narula N, Peerani F, Meserve J, Kochhar G, Chaudrey K, Hartke J, et al. Vedolizumab for ulcerative colitis: treatment outcomes from the VICTORY consortium. Am J Gastroenterol. 2018;113(9):1345. https://doi.org/10.1038/s41395-018-0162-0.

  23. 23.

    •• Sands BE, Peyrin-Biroulet L, Loftus EV Jr, Danese S, Colombel JF, Toruner M, et al. Vedolizumab versus adalimumab for moderate-to-severe ulcerative colitis. N Engl J Med. 2019;381(13):1215–26. https://doi.org/10.1056/NEJMoa1905725 This is the first head to head study performed comparing 2 biologic therapies, vedolizumab and adalimumab, in moderate to severe ulcerative colitis.

  24. 24.

    Dulai PS, Singh S, Jiang X, Peerani F, Narula N, Chaudrey K, et al. The real-world effectiveness and safety of vedolizumab or moderate-severe Crohn’s disease: results from the US VICTORY consortium. Am J Gastroenterol. 2016;111(8):1147–55. https://doi.org/10.1038/ajg.2016.236.

  25. 25.

    Danese S, Sands B, O’Brien C, Zhang H, Johanns J, Sloan S, et al. Efficacy and safety of ustekinumab through week 16 in patients with moderate to severe ulcerative colitis randomized to ustekinumab: results from the UNIFI induction trial. Digest Dis Weekly. 2019:Tu1739.

  26. 26.

    Sands BE, Sandborn WJ, Panaccione R, O’Brien CD, Zhang H, Johanns J, et al. Ustekinumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2019;381(13):1201–14. https://doi.org/10.1056/NEJMoa1900750.

  27. 27.

    Feagan BG, Sandborn WJ, Gasink C, Jacobstein D, Lang Y, Friedman JR, et al. Ustekinumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2016;375(20):1946–60. https://doi.org/10.1056/NEJMoa1602773.

  28. 28.

    Pugliese D, Daperno M, Fiorino G, Savarino E, Mosso E, Biancone L, et al. Real-life effectiveness of ustekinumab in inflammatory bowel disease patients with concomitant psoriasis or psoriatic arthritis: an IG-IBD study. Dig Liver Dis. 2019;51(7):972–7. https://doi.org/10.1016/j.dld.2019.03.007.

  29. 29.

    Souto A, Maneiro JR, Salgado E, Carmona L, Gomez-Reino JJ. Risk of tuberculosis in patients with chronic immune-mediated inflammatory diseases treated with biologics and tofacitinib: a systematic review and meta-analysis of randomized controlled trials and long-term extension studies. Rheumatology (Oxford). 2014;53(10):1872–85. https://doi.org/10.1093/rheumatology/keu172.

  30. 30.

    Gisbert JP, Chaparro M. Ustekinumab to treat Crohn’s disease. Gastroenterol Hepatol. 2017;40(10):688–98. https://doi.org/10.1016/j.gastrohep.2017.08.006.

  31. 31.

    Sandborn WJ, Su C, Sands BE, D’Haens GR, Vermeire S, Schreiber S, et al. Tofacitinib as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2017;376(18):1723–36. https://doi.org/10.1056/NEJMoa1606910.

  32. 32.

    Tofacitinib [package insert] New York, NY: Pfizer; 2019.

  33. 33.

    Ha C, Ullman TA, Siegel CA, Kornbluth A. Patients enrolled in randomized controlled trials do not represent the inflammatory bowel disease patient population. Clin Gastroenterol Hepatol. 2012;10(9):1002–7; quiz e78. https://doi.org/10.1016/j.cgh.2012.02.004.

  34. 34.

    Singh S, Proudfoot JA, Dulai PS, Xu R, Feagan BG, Sandborn WJ, et al. Efficacy and speed of induction of remission of infliximab vs golimumab for patients with ulcerative colitis, based on data from clinical trials. Clin Gastroenterol Hepatol. 2019. https://doi.org/10.1016/j.cgh.2019.05.019.

  35. 35.

    Narula N, Marshall JK, Colombel JF, Leontiadis GI, Williams JG, Muqtadir Z, et al. Systematic review and meta-analysis: infliximab or cyclosporine as rescue therapy in patients with severe ulcerative colitis refractory to steroids. Am J Gastroenterol. 2016;111(4):477–91. https://doi.org/10.1038/ajg.2016.7.

  36. 36.

    Jarnerot G, Hertervig E, Friis-Liby I, Blomquist L, Karlen P, Granno C, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology. 2005;128(7):1805–11. https://doi.org/10.1053/j.gastro.2005.03.003.

  37. 37.

    Laharie D, Bourreille A, Branche J, Allez M, Bouhnik Y, Filippi J, et al. Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial. Lancet. 2012;380(9857):1909–15. https://doi.org/10.1016/S0140-6736(12)61084-8.

  38. 38.

    Feagan BG, Lasch K, Lissoos T, Cao C, Wojtowicz AM, Khalid JM, et al. Rapid response to vedolizumab therapy in biologic-naive patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2019;17(1):130–8 e7. https://doi.org/10.1016/j.cgh.2018.05.026.

  39. 39.

    Sands BE, Sandborn WJ, Van Assche G, Lukas M, Xu J, James A, et al. Vedolizumab as induction and maintenance therapy for Crohn’s disease in patients naive to or who have failed tumor necrosis factor antagonist therapy. Inflamm Bowel Dis. 2017;23(1):97–106. https://doi.org/10.1097/MIB.0000000000000979.

  40. 40.

    Hanauer S, Panaccione R, Danese S, Cheifetz A, Reinisch W, Higgins PDR, et al. Tofacitinib induction therapy reduces symptoms within 3 days for patients with ulcerative colitis. Clin Gastroenterol Hepatol. 2019;17(1):139–47. https://doi.org/10.1016/j.cgh.2018.07.009.

  41. 41.

    Berinstein JA, Steiner CA, Regal RE, Allen JI, Kinnucan JAR, Stidham RW, et al. Efficacy of induction therapy with high-intensity tofacitinib in 4 patients with acute severe ulcerative colitis. Clin Gastroenterol Hepatol. 2019;17(5):988–90 e1. https://doi.org/10.1016/j.cgh.2018.11.022.

  42. 42.

    Lichtenstein GR, Feagan BG, Cohen RD, Salzberg BA, Safdi M, Popp JW Jr, et al. Infliximab for Crohn’s disease: more than 13 years of real-world experience. Inflamm Bowel Dis. 2018;24(3):490–501. https://doi.org/10.1093/ibd/izx072.

  43. 43.

    Siegel CA, Marden SM, Persing SM, Larson RJ, Sands BE. Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn’s disease: a meta-analysis. Clin Gastroenterol Hepatol. 2009;7(8):874–81. https://doi.org/10.1016/j.cgh.2009.01.004.

  44. 44.

    •• Colombel JF, Sands BE, Rutgeerts P, Sandborn W, Danese S, D’Haens G, et al. The safety of vedolizumab for ulcerative colitis and Crohn’s disease. Gut. 2017;66(5):839–51. https://doi.org/10.1136/gutjnl-2015-311079 This was a pooled safety analysis of all randomized controlled trials with vedolizumab showing lower rates of adverse and serious adverse events with this therapy compated with placebo.

  45. 45.

    Meserve J, Aniwan S, Koliani-Pace JL, Shashi P, Weiss A, Faleck D, et al. Retrospective analysis of safety of vedolizumab in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2019;17(8):1533–40 e2. https://doi.org/10.1016/j.cgh.2018.09.035.

  46. 46.

    Bye WA, Jairath V, Travis SPL. Systematic review: the safety of vedolizumab for the treatment of inflammatory bowel disease. Aliment Pharmacol Ther. 2017;46(1):3–15. https://doi.org/10.1111/apt.14075.

  47. 47.

    Papp K, Gottlieb AB, Naldi L, Pariser D, Ho V, Goyal K, et al. Safety surveillance for ustekinumab and other psoriasis treatments from the psoriasis longitudinal assessment and registry (PSOLAR). J Drugs Dermatol. 2015;14(7):706–14.

  48. 48.

    Sands BE, Taub PR, Armuzzi A, Friedman GS, Moscariello M, Lawendy N, et al. Tofacitinib treatment is associated with modest and reversible increases in serum lipids in patients with ulcerative colitis. Clin Gastroenterol Hepatol. 2019. https://doi.org/10.1016/j.cgh.2019.04.059.

  49. 49.

    Winthrop KL, Melmed GY, Vermeire S, Long MD, Chan G, Pedersen RD, et al. Herpes zoster infection in patients with ulcerative colitis receiving tofacitinib. Inflamm Bowel Dis. 2018;24(10):2258–65. https://doi.org/10.1093/ibd/izy131.

  50. 50.

    •• Drug Safety Communication. Food and Drug Administration. Available at https://www.fda.gov/media/120485/download. Accessed September 9, 2019. This communication from the FDA reported increased risk of pulmonary embolism and mortality in rheumatoid arthritis pateints over the age of 50 with at least one cardiac risk factor on tofacitinib 10mg twice daily.

  51. 51.

    Singh S, Fumery M, Sandborn WJ, Murad MH. Systematic review with network meta-analysis: first- and second-line pharmacotherapy for moderate-severe ulcerative colitis. Aliment Pharmacol Ther. 2018;47(2):162–75. https://doi.org/10.1111/apt.14422.

  52. 52.

    Hazlewood GS, Rezaie A, Borman M, Panaccione R, Ghosh S, Seow CH, et al. Comparative effectiveness of immunosuppressants and biologics for inducing and maintaining remission in Crohn’s disease: a network meta-analysis. Gastroenterology. 2015;148(2):344–54 e5; quiz e14–5. https://doi.org/10.1053/j.gastro.2014.10.011.

  53. 53.

    Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of Crohn’s disease in adults. Am J Gastroenterol. 2018;113(4):481–517. https://doi.org/10.1038/ajg.2018.27.

  54. 54.

    Frolkis AD, Lipton DS, Fiest KM, Negron ME, Dykeman J, de Bruyn J, et al. Cumulative incidence of second intestinal resection in Crohn’s disease: a systematic review and meta-analysis of population-based studies. Am J Gastroenterol. 2014;109(11):1739–48. https://doi.org/10.1038/ajg.2014.297.

  55. 55.

    Nguyen GC, Loftus EV Jr, Hirano I, Falck-Ytter Y, Singh S, Sultan S, et al. American Gastroenterological Association Institute guideline on the management of Crohn’s disease after surgical resection. Gastroenterology. 2017;152(1):271–5. https://doi.org/10.1053/j.gastro.2016.10.038.

  56. 56.

    Singh S, Garg SK, Pardi DS, Wang Z, Murad MH, Loftus EV Jr. Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn’s disease after surgery: a systematic review and network meta-analysis. Gastroenterology. 2015;148(1):64–76 e2; quiz e14. https://doi.org/10.1053/j.gastro.2014.09.031.

  57. 57.

    •• Regueiro M, Feagan BG, Zou B, Johanns J, Blank MA, Chevrier M, et al. Infliximab reduces endoscopic, but not clinical, recurrence of Crohn’s disease after ileocolonic resection. Gastroenterology. 2016;150(7):1568–78. https://doi.org/10.1053/j.gastro.2016.02.072 In this multicenter randomized controlled trial, infliximab was showed to decreased endoscopic recurrence of CD after resection.

  58. 58.

    Regueiro M, Kip KE, Baidoo L, Swoger JM, Schraut W. Postoperative therapy with infliximab prevents long-term Crohn’s disease recurrence. Clin Gastroenterol Hepatol. 2014;12(9):1494–502 e1. https://doi.org/10.1016/j.cgh.2013.12.035.

  59. 59.

    De Cruz P, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A, et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet. 2015;385(9976):1406–17. https://doi.org/10.1016/S0140-6736(14)61908-5.

  60. 60.

    De Cruz P, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A, et al. Efficacy of thiopurines and adalimumab in preventing Crohn’s disease recurrence in high-risk patients-a POCER study analysis. Aliment Pharmacol Ther. 2015;42(7):867–79. https://doi.org/10.1111/apt.13353.

  61. 61.

    Lopez-Sanroman A, Vera-Mendoza I, Domenech E, Taxonera C, Vega Ruiz V, Marin-Jimenez I, et al. Adalimumab vs azathioprine in the prevention of postoperative Crohn’s disease recurrence. A GETECCU randomised trial. J Crohns Colitis. 2017;11(11):1293–301. https://doi.org/10.1093/ecco-jcc/jjx051.

  62. 62.

    Yamada A, Komaki Y, Patel N, Komaki F, Pekow J, Dalal S, et al. The use of vedolizumab in preventing postoperative recurrence of Crohn’s disease. Inflamm Bowel Dis. 2018;24(3):502–9. https://doi.org/10.1093/ibd/izx054.

  63. 63.

    Mahadevan U, Robinson C, Bernasko N, Boland B, Chambers C, Dubinsky M, et al. Inflammatory bowel disease in pregnancy clinical care pathway: a report from the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology. 2019;156(5):1508–24. https://doi.org/10.1053/j.gastro.2018.12.022.

  64. 64.

    Abhyankar A, Ham M, Moss AC. Meta-analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;38(5):460–6. https://doi.org/10.1111/apt.12417.

  65. 65.

    Mahadevan U, McConnell RA, Chambers CD. Drug safety and risk of adverse outcomes for pregnant patients with inflammatory bowel disease. Gastroenterology. 2017;152(2):451–62 e2. https://doi.org/10.1053/j.gastro.2016.10.013.

  66. 66.

    Luu M, Benzenine E, Doret M, Michiels C, Barkun A, Degand T, et al. Continuous anti-TNFalpha use throughout pregnancy: possible complications for the mother but not for the fetus. A retrospective cohort on the French National Health Insurance Database (EVASION). Am J Gastroenterol. 2018;113(11):1669–77. https://doi.org/10.1038/s41395-018-0176-7.

  67. 67.

    Mahadevan U. PIANO: a 1000 patient prospective registry of pregnancy outcomes in women with IBD exposed to immunomodulators and biologic therapy. Gastroenterology. 2012;142(S–149).

  68. 68.

    Bar-Gil Shitrit A, Ben Ya’acov A, Livovsky DM, Cuker T, Farkash R, Hoyda A, et al. Exposure to vedolizumab in IBD pregnant women appears of low risk for mother and neonate: a first prospective comparison study. Am J Gastroenterol. 2019;114(7):1172–5. https://doi.org/10.14309/ajg.0000000000000186.

  69. 69.

    Moens A, van Hoeve K, Humblet E, Rahier JF, Bossuyt P, Dewit S, et al. Outcome of pregnancies in female patients with inflammatory bowel diseases treated with vedolizumab. J Crohns Colitis. 2019;13(1):12–8. https://doi.org/10.1093/ecco-jcc/jjy142.

  70. 70.

    Danese S, Semeraro S, Papa A, Roberto I, Scaldaferri F, Fedeli G, et al. Extraintestinal manifestations in inflammatory bowel disease. World J Gastroenterol. 2005;11(46):7227–36. https://doi.org/10.3748/wjg.v11.i46.7227.

  71. 71.

    Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001;96(4):1116–22. https://doi.org/10.1111/j.1572-0241.2001.03756.x.

  72. 72.

    Feagan BG, Sandborn WJ, Colombel JF, Byrne SO, Khalid JM, Kempf C, et al. Incidence of arthritis/arthralgia in inflammatory bowel disease with long-term vedolizumab treatment: post hoc analyses of the GEMINI trials. J Crohns Colitis. 2019;13(1):50–7. https://doi.org/10.1093/ecco-jcc/jjy125.

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Correspondence to David Hudesman.

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David Hudesman is a consultant for Abbvie, Janssen, Salix, Takeda, and Pfizer.

Shannon Chang is a consultant for Takeda, Oshi Health, and Pfizer.

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Chang, S., Hudesman, D. First-Line Biologics or Small Molecules in Inflammatory Bowel Disease: a Practical Guide for the Clinician. Curr Gastroenterol Rep 22, 7 (2020). https://doi.org/10.1007/s11894-020-0745-y

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  • Positioning biologics
  • Inflammatory bowel disease
  • Infliximab
  • Adalimumab, vedolizumab
  • Tofacitinib
  • Ustekinumab