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
Last, what are living guidelines? 🧑🍼
🔹With how quickly drug-development 💊 and treatment strategies ♟️ change, AGA will review new lit. 📄 and update recommendations as needed every 6 months 📝.
Stay tuned for updates in the future!
10/10
🔹With how quickly drug-development 💊 and treatment strategies ♟️ change, AGA will review new lit. 📄 and update recommendations as needed every 6 months 📝.
Stay tuned for updates in the future!
10/10
November 20, 2025 at 6:59 PM
Last, what are living guidelines? 🧑🍼
🔹With how quickly drug-development 💊 and treatment strategies ♟️ change, AGA will review new lit. 📄 and update recommendations as needed every 6 months 📝.
Stay tuned for updates in the future!
10/10
🔹With how quickly drug-development 💊 and treatment strategies ♟️ change, AGA will review new lit. 📄 and update recommendations as needed every 6 months 📝.
Stay tuned for updates in the future!
10/10
✳️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
❗️Important❗️
🔑High🪣or med🪣 > lower🪣 🔑
You need to factor in the patient when making tx choices, not just focus on which efficacy bucket each medication is in.
Consider age 👨🦳, pregnancy status 🤰, comorbidities 🤒, functional status 👩🦽, prior med exposures, & patient preferences.
5/10
🔑High🪣or med🪣 > lower🪣 🔑
You need to factor in the patient when making tx choices, not just focus on which efficacy bucket each medication is in.
Consider age 👨🦳, pregnancy status 🤰, comorbidities 🤒, functional status 👩🦽, prior med exposures, & patient preferences.
5/10
November 20, 2025 at 6:59 PM
❗️Important❗️
🔑High🪣or med🪣 > lower🪣 🔑
You need to factor in the patient when making tx choices, not just focus on which efficacy bucket each medication is in.
Consider age 👨🦳, pregnancy status 🤰, comorbidities 🤒, functional status 👩🦽, prior med exposures, & patient preferences.
5/10
🔑High🪣or med🪣 > lower🪣 🔑
You need to factor in the patient when making tx choices, not just focus on which efficacy bucket each medication is in.
Consider age 👨🦳, pregnancy status 🤰, comorbidities 🤒, functional status 👩🦽, prior med exposures, & patient preferences.
5/10
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
Forever in camp OC
November 8, 2025 at 4:43 PM
Forever in camp OC
Appropriately so. Easily the most peripheral and unnecessary subscription I have. Garmin is my recorder, any serious analytics are happening in trainerroad or trainingpeaks. I often wonder why i still even pay for Strava, other than an easy interface for the grams.
October 3, 2025 at 5:45 PM
Appropriately so. Easily the most peripheral and unnecessary subscription I have. Garmin is my recorder, any serious analytics are happening in trainerroad or trainingpeaks. I often wonder why i still even pay for Strava, other than an easy interface for the grams.
lotta potential cavities in that basket of cookies though. He's looking out for your future dental health
September 30, 2025 at 5:57 PM
lotta potential cavities in that basket of cookies though. He's looking out for your future dental health
Apparently more so for some than others?
August 31, 2025 at 4:40 PM
Apparently more so for some than others?
Crushed, but will get over it
August 5, 2025 at 12:44 AM
Crushed, but will get over it
I think the 11th edition of the newspeak dictionary is due any day now, right?
June 28, 2025 at 4:21 PM
I think the 11th edition of the newspeak dictionary is due any day now, right?
Everything that is old is new again.
June 27, 2025 at 7:49 PM
Everything that is old is new again.