Rationale for Correct Answer
The correct answer is: Treatment with a biologic or small molecule is warranted at this time, based on disease severity
The Mayo score is an assessment tool for UC commonly used in clinical practice to determine disease severity. It is a combination of patient-reported outcomes, the physician’s global assessment, and endoscopic findings.1 In addition to the full assessment, there are Modified and Partial Mayo Scores whose results correlate with the full assessment.2 The modified Mayo Score does not include the Physician’s Global Assessment, making it useful for clinical trials. The Partial Mayo Score does not include the endoscopy score, making it useful in clinical practice if endoscopy is not otherwise being done. For patients with CD, the Crohn’s Disease Activity Index (CDAI) is commonly used to assess disease severity in clinical trials.3 According to the Mayo Score, this patient has moderate CD. For patients with moderate-to-severe IBD, biologics or small-molecule therapies are recommended for first-line treatment.1,3-5 For patients with a high risk of infection, immunomodulatory therapy should be considered with care.1,6 Vedolizumab would be an appropriate first-line therapy, according to AGA recommendations.1 It may be less effective in patients who are anti-TNF-α nonresponders.7
References:
1. Feurstein JD et al. Gastroenterology. 2020;158(5):1450-61;
2. Naegeli AN et al. Crohns Colitis 360. 2021;3(1):otab007;
3. Feurstein JD et al. Gastroenterology. 2021;160(7):2496-2508;
4. Lichtenstein GR et al. Am J Gastroenterol. 2018;113(4):481-517;
5. Rubin DT et al. Am J Gastroenterol. 2019;114(3):384-413;
6. Garcia NM et al. United European Gastroenterol J. 2022; 10(10):1121-8;
7. Bressler B. Therap Adv Gastroenterol. 2023;16:17562848231159452.