🧠 Practice-changing updates: AGA 2025 Guideline on Moderate-to-Severe Crohn’s Disease

🔥 Key actionable highlights:

• Vedolizumab is recommended over no treatment for moderate-severe Crohn’s disease, but not preferred to higher-efficacy agents (infliximab, adalimumab, ustekinumab, risankizumab, mirikizumab, guselkumab) in biologics-naïve patients.
• For patients exposed to ≥1 advanced therapy, “higher efficacy” (adalimumab, risankizumab, guselkumab, upadacitinib) or “intermediate efficacy” (ustekinumab, mirikizumab) agents are suggested over “lower efficacy” options (vedolizumab, certolizumab pegol).
• Avoid thiopurine monotherapy for induction; consider advanced therapy initiation upfront in moderately-to-severely active cases.

🧪 Evidence base: American Gastroenterological Association expert panel, GRADE approach, >16 recommendations, living document.

📍 What this changes: When initiating pharmacologic therapy in Crohn's disease, vedolizumab remains an option but consider patient history with advanced therapies and clinical phenotype to guide optimal agent selection—especially important in moderate-to-severe IBD.

🔗 PubMed | DOI

🫀 Network Meta-analysis: Advanced therapies and QoL in Moderate-to-Severe UC

🔥 Main in 3 points:

• Both upadacitinib and vedolizumab demonstrate improvements in HRQoL (IBDQ, SF-36, WPAI-UC) in moderate-to-severe UC.
• Vedolizumab shows HRQoL benefits mainly in maintenance therapy and for work productivity.
• Upadacitinib often ranks highest, but vedolizumab remains one of the agents with evidence of quality-of-life improvements.

🧪 Context: Systematic review and network meta-analysis of 28 RCTs (adults, moderate–severe UC), focusing on validated HRQoL metrics.

📍 Practical significance: When selecting advanced therapies for UC, consider patient-reported quality-of-life outcomes (not just symptom control). Vedolizumab can contribute to QoL and work productivity improvements, making it relevant for shared decision-making with patients.

🔗 PubMed | DOI

🧩 Machine learning spots predictors of response to vedolizumab & ustekinumab in IBD

🧪 What was studied: Spanish real-world study (n=227) used XGBoost models to predict response and remission at 26 and 52 weeks in IBD treated with vedolizumab/ustekinumab. Key predictors: leukocyte count, fecal calprotectin (FCP), CRP, vitamin B12.

📈 Key results: Higher inflammatory markers (CRP, FCP) = poorer response likelihood. Model accuracy (F1) ranged 0.649–0.869. Demographic subgroup (age, sex) analysis showed some model variability.

📍 What this changes: Regular inflammatory marker tracking can inform real-world response, and clinical decision-support tools using machine learning could be on the horizon. Further validation needed, but future practice may incorporate AI-driven personalized therapy guidance for IBD patients.

🔗 Source: PubMed | DOI