After this activity, the participant will be able to compare the efficacy of adalimumab, infliximab, ustekinumab, and vedolizumab on the ability to achieve endoscopic healing in patients with moderate to severe Crohn's disease.
A 42-year-old man with a recent diagnosis of Crohn's disease presents with non-bloody diarrhea and weight loss, which has been present for 2 months prior to admission. On examination, he is afebrile with blood pressure of 120/70 and a pulse rate of 84 bpm. His examination is significant for mild right lower quadrant tenderness without rebound or guarding. There is no organomegaly. A colonoscopy with intubation of the terminal ileum reveals normal colonic mucosa. There is diffuse inflammation in the ileum with 3 deep ulcerations, each measuring 1.5 cm. Laboratory evaluation revealed no Clostridium difficile toxins in the stool, a mildly elevated C-reactive protein of 5, normal white blood count (WBC) of 5.9, decreased hemoglobin 9.8 g/dL, and a normal liver, renal, and electrolyte profile.
Which biologic therapy would be the most appropriate to initiate in this patient to best allow for mucosal healing?
- A. Adalimumab
- B. Vedolizumab
- C. Infliximab
- D. Ustekinumab
A 23-year-old woman presents with new onset non-bloody diarrhea, cramping right lower quadrant pain, and a 15-pound weight loss over the past month. She undergoes colonoscopy, which reveals inflammation and multiple 1-cm ulcers in the sigmoid colon, descending colon, splenic flexure, and transverse colon. Biopsies in these segments indicate chronic active inflammation without dysplasia. A single granuloma is seen. Intubation of the terminal ileum is significant for normal mucosa endoscopically and biopsies are also normal. An magnetic resonance elastography is performed, which shows no abnormality of the small bowel and some mild thickening in the left and transverse colon. A diagnosis of Crohn's disease is made based on these findings. Further evaluation with lab work reveals no infectious etiology, a normal comprehensive metabolic panel, mild anemia with HgB 10.5 mg/dL, fecal calprotectin 550, and WBC 6.6.
Which biologic agent has the lowest efficacy in endoscopic healing for patients with isolated colonic Crohn's disease?
- A. Vedolizumab
- B. Ustekinumab
- C. Adalimumab
- D. Infliximab
Which of the following is not a component of the Simple Endoscopic Score for Crohn's Disease (SES-CD score)?
- A. Presence and size of ulcerations
- B. Extent of ulcerated surfaces
- C. Presence of narrowings
- D. Presence of spontaneous bleeding