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Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
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Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
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Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
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Introduction
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
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Week 12 Reduction in Modified Multiplier of the Simple Endoscopic Score for Crohn's Disease is Predictive of Delayed

Emily C L Wong1, Parambir S Dulai2, John K Marshall1

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Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|December 28, 2025
PubMed
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Delayed clinical response to upadacitinib in Crohn's disease is common. Early reduction in Modified Multiplier of the SES-CD (MM-SES-CD) by week 12 predicts delayed response, aiding treatment decisions.

Keywords:
Crohn’s DiseaseMM-SES-CDUpadacitinib

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Delayed responses to treatments are known in inflammatory bowel disease (IBD).
  • Characteristics of delayed responders to upadacitinib in Crohn's disease (CD) are not well understood.
  • Early markers for identifying delayed responders to upadacitinib in CD are needed.

Purpose of the Study:

  • To evaluate early endoscopic and biochemical markers.
  • To identify patients with CD exhibiting delayed response to upadacitinib.
  • To compare delayed responders with non-responders.

Main Methods:

  • Post-hoc analysis of U-EXCEED and U-EXCEL trial data.
  • Patients with moderate-to-severe CD received upadacitinib.
  • Delayed responders were defined as non-responders at week 12 who responded by week 24.

Main Results:

  • 29.2% of patients were non-responders at week 12; 52.5% of these achieved delayed response by week 24.
  • Most delayed responders (79.7%) had ≥20% reduction in MM-SES-CD by week 12.
  • Failure to achieve ≥20% MM-SES-CD reduction by week 12 predicted delayed non-response (aOR: 0.22; p=0.001).
  • Endoscopic burden (SES-CD) and inflammatory biomarkers were not predictive of delayed response.

Conclusions:

  • Delayed clinical response to upadacitinib is observed in a significant portion of initial non-responders.
  • Lack of week 12 MM-SES-CD reduction indicates a high likelihood of delayed non-response.
  • MM-SES-CD at week 12 is a useful marker for guiding upadacitinib treatment decisions in CD.