Frank I. Scott, MD MSCE
@frankiscottmd.bsky.social
Gastroenterologist specializing in IBD and epidemiology at the University of Colorado, APD of GI Fellowship program, Co-Director of GI Outcomes Research Group, Co- Director of IBD QORUS, avid philly sports fan, cyclist
✳️15. For patients w/ mod-severe disease:
👍 Early advanced therapy
❌ No step-up 🪜 therapy
✳️16.🤷♂️Knowledge gap re: treating to a target of mucosal healing vs clinical remission. More data needed!
👍 Early advanced therapy
❌ No step-up 🪜 therapy
✳️16.🤷♂️Knowledge gap re: treating to a target of mucosal healing vs clinical remission. More data needed!
November 20, 2025 at 6:59 PM
✳️15. For patients w/ mod-severe disease:
👍 Early advanced therapy
❌ No step-up 🪜 therapy
✳️16.🤷♂️Knowledge gap re: treating to a target of mucosal healing vs clinical remission. More data needed!
👍 Early advanced therapy
❌ No step-up 🪜 therapy
✳️16.🤷♂️Knowledge gap re: treating to a target of mucosal healing vs clinical remission. More data needed!
✳️13, ✳️14 For TNF + IMM therapy, should you stop?
👍 Consider stopping IMM if in steroid-free remission >6mo
❌ Don’t stop TNF
Should involve shared decision making, consideration of disease severity + history, comorbidities, and risk of immunogenicity
8/10
👍 Consider stopping IMM if in steroid-free remission >6mo
❌ Don’t stop TNF
Should involve shared decision making, consideration of disease severity + history, comorbidities, and risk of immunogenicity
8/10
November 20, 2025 at 6:59 PM
✳️13, ✳️14 For TNF + IMM therapy, should you stop?
👍 Consider stopping IMM if in steroid-free remission >6mo
❌ Don’t stop TNF
Should involve shared decision making, consideration of disease severity + history, comorbidities, and risk of immunogenicity
8/10
👍 Consider stopping IMM if in steroid-free remission >6mo
❌ Don’t stop TNF
Should involve shared decision making, consideration of disease severity + history, comorbidities, and risk of immunogenicity
8/10
✳️9, ✳️10, ✳️11, ✳️12 Combo therapy 💊+💊
🔹 IFX + thiopurine > IFX or thiopurine alone, particularly if no prior thiopurine use.
🤷♂️Knowledge gaps: Combo therapy with MTX, ADA+ IMM, or non-TNF biologics + IMM
7/10
🔹 IFX + thiopurine > IFX or thiopurine alone, particularly if no prior thiopurine use.
🤷♂️Knowledge gaps: Combo therapy with MTX, ADA+ IMM, or non-TNF biologics + IMM
7/10
November 20, 2025 at 6:59 PM
✳️9, ✳️10, ✳️11, ✳️12 Combo therapy 💊+💊
🔹 IFX + thiopurine > IFX or thiopurine alone, particularly if no prior thiopurine use.
🤷♂️Knowledge gaps: Combo therapy with MTX, ADA+ IMM, or non-TNF biologics + IMM
7/10
🔹 IFX + thiopurine > IFX or thiopurine alone, particularly if no prior thiopurine use.
🤷♂️Knowledge gaps: Combo therapy with MTX, ADA+ IMM, or non-TNF biologics + IMM
7/10
✳️5, ✳️6, ✳️7.✳️ 8 Immunomodulators 💊
❌ Thiopurines for induction
👍 Okay to use thiopurines for maintenance
👍Methotrexate SQ for induction or maintenance
❌Methotrexate PO for induction or maintenance
6/10
❌ Thiopurines for induction
👍 Okay to use thiopurines for maintenance
👍Methotrexate SQ for induction or maintenance
❌Methotrexate PO for induction or maintenance
6/10
November 20, 2025 at 6:59 PM
✳️5, ✳️6, ✳️7.✳️ 8 Immunomodulators 💊
❌ Thiopurines for induction
👍 Okay to use thiopurines for maintenance
👍Methotrexate SQ for induction or maintenance
❌Methotrexate PO for induction or maintenance
6/10
❌ Thiopurines for induction
👍 Okay to use thiopurines for maintenance
👍Methotrexate SQ for induction or maintenance
❌Methotrexate PO for induction or maintenance
6/10
What about comparative efficacy for bio-naïve & bio-exposed?
✳️3. Bio naive: Higher 🪣> Lower 🪣
Higher🪣: IFX, ADA, VDZ, UST, RIS, MIR, GUS
Lower🪣: CTP, UPA
✳️4. Exposed: Higher 🪣 or Med 🪣 > Lower 🪣
Higher🪣: ADA, RIS, GUS, UPA
Med🪣: UST, MIR
Lower🪣: VDZ, CTP
4/10
✳️3. Bio naive: Higher 🪣> Lower 🪣
Higher🪣: IFX, ADA, VDZ, UST, RIS, MIR, GUS
Lower🪣: CTP, UPA
✳️4. Exposed: Higher 🪣 or Med 🪣 > Lower 🪣
Higher🪣: ADA, RIS, GUS, UPA
Med🪣: UST, MIR
Lower🪣: VDZ, CTP
4/10
November 20, 2025 at 6:59 PM
What about comparative efficacy for bio-naïve & bio-exposed?
✳️3. Bio naive: Higher 🪣> Lower 🪣
Higher🪣: IFX, ADA, VDZ, UST, RIS, MIR, GUS
Lower🪣: CTP, UPA
✳️4. Exposed: Higher 🪣 or Med 🪣 > Lower 🪣
Higher🪣: ADA, RIS, GUS, UPA
Med🪣: UST, MIR
Lower🪣: VDZ, CTP
4/10
✳️3. Bio naive: Higher 🪣> Lower 🪣
Higher🪣: IFX, ADA, VDZ, UST, RIS, MIR, GUS
Lower🪣: CTP, UPA
✳️4. Exposed: Higher 🪣 or Med 🪣 > Lower 🪣
Higher🪣: ADA, RIS, GUS, UPA
Med🪣: UST, MIR
Lower🪣: VDZ, CTP
4/10
✳️1 & 2: What therapies are recommended compared to placebo?
Strong rec: IFX, ADA, UST, RIS, GUS, MIR, UPA
Conditional rec: CTP, VDZ
Considerations:
1. Biosimilar = originator
2. SQ = IV
3. If severe disease, consider extended induction, dose esc, and higher maintenance doses.
3/10
Strong rec: IFX, ADA, UST, RIS, GUS, MIR, UPA
Conditional rec: CTP, VDZ
Considerations:
1. Biosimilar = originator
2. SQ = IV
3. If severe disease, consider extended induction, dose esc, and higher maintenance doses.
3/10
November 20, 2025 at 6:59 PM
✳️1 & 2: What therapies are recommended compared to placebo?
Strong rec: IFX, ADA, UST, RIS, GUS, MIR, UPA
Conditional rec: CTP, VDZ
Considerations:
1. Biosimilar = originator
2. SQ = IV
3. If severe disease, consider extended induction, dose esc, and higher maintenance doses.
3/10
Strong rec: IFX, ADA, UST, RIS, GUS, MIR, UPA
Conditional rec: CTP, VDZ
Considerations:
1. Biosimilar = originator
2. SQ = IV
3. If severe disease, consider extended induction, dose esc, and higher maintenance doses.
3/10
📍Used GRADE framework
📍Thresholds for clinically meaningful benefits across txs: >10% vs. pbo & >5% vs. other 💊
📍For those with no prior adv tx exposure, meds were stratified into higher vs lower efficacy. For adv tx-exposed, higher-, medium-, and lower-eff. buckets were used.
2/10
📍Thresholds for clinically meaningful benefits across txs: >10% vs. pbo & >5% vs. other 💊
📍For those with no prior adv tx exposure, meds were stratified into higher vs lower efficacy. For adv tx-exposed, higher-, medium-, and lower-eff. buckets were used.
2/10
November 20, 2025 at 6:59 PM
📍Used GRADE framework
📍Thresholds for clinically meaningful benefits across txs: >10% vs. pbo & >5% vs. other 💊
📍For those with no prior adv tx exposure, meds were stratified into higher vs lower efficacy. For adv tx-exposed, higher-, medium-, and lower-eff. buckets were used.
2/10
📍Thresholds for clinically meaningful benefits across txs: >10% vs. pbo & >5% vs. other 💊
📍For those with no prior adv tx exposure, meds were stratified into higher vs lower efficacy. For adv tx-exposed, higher-, medium-, and lower-eff. buckets were used.
2/10
🚨AGA New Guideline Alert🚨
@amergastroassn.bsky.social
🔗https://smplu.link/aga_CD_guidelines
▶️AGA Living Guideline: Pharmacologic Management of Moderate-to-Severe Crohn’s Disease
I’ll break down its 16 recommendations down over the next 10 tweets 🧵 👇
#AGA #GI #CD #IBD #MedTwitter
1/10
@amergastroassn.bsky.social
🔗https://smplu.link/aga_CD_guidelines
▶️AGA Living Guideline: Pharmacologic Management of Moderate-to-Severe Crohn’s Disease
I’ll break down its 16 recommendations down over the next 10 tweets 🧵 👇
#AGA #GI #CD #IBD #MedTwitter
1/10
November 20, 2025 at 6:59 PM
🚨AGA New Guideline Alert🚨
@amergastroassn.bsky.social
🔗https://smplu.link/aga_CD_guidelines
▶️AGA Living Guideline: Pharmacologic Management of Moderate-to-Severe Crohn’s Disease
I’ll break down its 16 recommendations down over the next 10 tweets 🧵 👇
#AGA #GI #CD #IBD #MedTwitter
1/10
@amergastroassn.bsky.social
🔗https://smplu.link/aga_CD_guidelines
▶️AGA Living Guideline: Pharmacologic Management of Moderate-to-Severe Crohn’s Disease
I’ll break down its 16 recommendations down over the next 10 tweets 🧵 👇
#AGA #GI #CD #IBD #MedTwitter
1/10
Excited for the 7th annual IBD101 course, hosted by @amcollegegastro.bsky.social in Dallas, TX today! Fantastic educational program for first year gi fellows
September 13, 2025 at 2:06 PM
Excited for the 7th annual IBD101 course, hosted by @amcollegegastro.bsky.social in Dallas, TX today! Fantastic educational program for first year gi fellows
Towards better understanding how we should position advanced tx in UC:
Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Ulcerative Colitis: 2024 American Gastroenterological Association Evidence Synthesis - Gastroenterology www.gastrojournal.org/article/S001...
Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Ulcerative Colitis: 2024 American Gastroenterological Association Evidence Synthesis - Gastroenterology www.gastrojournal.org/article/S001...
November 12, 2024 at 10:38 PM
Towards better understanding how we should position advanced tx in UC:
Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Ulcerative Colitis: 2024 American Gastroenterological Association Evidence Synthesis - Gastroenterology www.gastrojournal.org/article/S001...
Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Ulcerative Colitis: 2024 American Gastroenterological Association Evidence Synthesis - Gastroenterology www.gastrojournal.org/article/S001...