In a 2023 head-to-head controlled trial, patients with Crohn disease who had not responded to prior anti-TNF therapies were randomized to induction and maintenance therapy with either risankizumab (360 mg subcutaneously every 8 weeks) or ustekinumab (90 mg subcutaneously every 8 weeks). After 48 weeks, clinical remission (61% versus 40%) and endoscopic remission (32% versus 16%) were significantly higher with risankizumab than ustekinumab, suggesting risankizumab may be the preferred anti-IL agent.

In a 2023 network meta-analysis of biologic and small molecule therapies, risankizumab ranked first in efficacy for patients with Crohn disease who had or had not received prior biologic therapies.

Barberio B et al. Gut. [PMID: 35907636]

For patients who have not responded or lost response to anti-TNF agents, vedolizumab appears to be less effective than anti-IL agents (risankizumab or ustekinumab).

In 2023, the oral JAK inhibitor upadacitinib was approved for induction and maintenance therapy for Crohn disease.

Network meta-analyses suggest upadacitinib may be equivalent to biologic agents in the treatment of Crohn disease and offers the convenience of oral therapy. However, in light of the uncertain risks of JAK inhibitors for serious complications (including thrombosis, cardiovascular events, and malignancy), upadacitinib should be reserved for patients who have failed biologic therapies.

Barberio B et al. Gut. [PMID: 35907636]

Loftus EV et al. N Engl J Med. [PMID: 37224198]