The document summarizes new guidelines from the American Gastroenterological Association (AGA) for treating Crohn's disease. It recommends using anti-TNF-α drugs to induce remission in patients with moderately severe Crohn's disease. It also recommends anti-TNF-α drugs or thiopurines to maintain remission and suggests various combination therapies based on the severity of symptoms and type of remission.

1. Mahrous Recommendation
Based on Best Evidence , Practice Guidelines & Expert Opinion
AGA Introduces New Guideline for Crohn’s Disease
December 06, 2013
Waleed Mahrous
Dr Waleed Kh. Mahrous
http://www.gastro.org/journals-publications/news/AGA-Introduces-New-Guideline-for-Crohn-s-Disease

2. Recommendations for the induction of remission
Dr Waleed Kh. Mahrous
 We suggest against using thiopurine
monotherapy to induce remission in patients
with moderately severe Crohn’s disease (weak
recommendation, moderate-quality evidence).
 We suggest against using methotrexate to
induce remission in patients with moderately
severe Crohn’s disease (weak
recommendation, low-quality evidence).
Dr Waleed Kh. Mahrous
http://www.gastro.org/journals-publications/news/AGA-Introduces-New-Guideline-for-Crohn-s-Disease

3. Recommendations for the induction of remission
 We recommend using anti-TNF-α drugs to
induce remission in patients with moderately
severe Crohn’s disease (strong
recommendation, moderate-quality evidence).
 We recommend using anti-TNF-α monotherapy over
thiopurine monotherapy to induce remission in
patients who have moderately severe Crohn’s disease
(strong recommendation, moderate-quality evidence).
Dr Waleed Kh. Mahrous
http://www.gastro.org/journals-publications/news/AGA-Introduces-New-Guideline-for-Crohn-s-Disease

4. Recommendations for the induction of remission
 We recommend using anti-TNF-α drugs in
combination with thiopurines over thiopurine
monotherapy to induce remission in patients who have
moderately severe Crohn’s disease (strong
recommendation, high-quality evidence).
 We suggest using anti-TNF-α drugs in combination
with thiopurines over anti-TNF-α drug monotherapy
to induce remission in patients who have moderately
severe Crohn’s disease (weak recommendation, moderatequality evidence).
Dr Waleed Kh. Mahrous
http://www.gastro.org/journals-publications/news/AGA-Introduces-New-Guideline-for-Crohn-s-Disease

5. Recommendations for maintenance of remission
 We recommend using thiopurines over no
immunomodulator therapy to maintain a
steroid-induced remission in patients with
Crohn’s disease (strong recommendation, moderatequality evidence).
 We suggest using methotrexate over no
immunomodulator therapy to maintain a
steroid-induced remission in patients with
Crohn’s disease (weak recommendation, low-quality
evidence).
Dr Waleed Kh. Mahrous
http://www.gastro.org/journals-publications/news/AGA-Introduces-New-Guideline-for-Crohn-s-Disease

6. Recommendations for maintenance of remission
 We recommend using anti-TNF-α drugs over no
anti-TNF-α drugs to maintain a steroid or antiTNF-α drug-induced remission in patients with
Crohn’s disease (strong recommendation, high-quality
evidence).
 We make no recommendation for or against the
combination of an anti-TNF-α drug and a
thiopurine versus an anti-TNF-α drug alone to
maintain remission induced by a combination of
these drugs in patients with Crohn’s disease (no
recommendation, low-quality evidence).
Dr Waleed Kh. Mahrous
http://www.gastro.org/journals-publications/news/AGA-Introduces-New-Guideline-for-Crohn-s-Disease