[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-435707-105":59,"doc-detail-435707-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","the-evolving-therapeutic-paradigm-for-achieving-remission-in-crohns-disease-letter-to-the-editor","The evolving therapeutic paradigm for achieving remission in Crohn’s disease - Letter to the Editor","","The letter discusses how Crohn’s disease care is shifting toward achieving profound, sustained remission amid rapidly expanding treatment options, from traditional immunomodulators to anti-TNF therapy and newer selective biologics and small compounds. It outlines clinical implications of therapeutic diversification, including alignment of mechanisms with patient-specific disease features, goals beyond symptom control such as endoscopic remission, and complexities in first-line choice, sequencing, and managing non-response. It highlights uncertainty around immunomodulator roles, lack of head-to-head data, and the need for better prognostic indicators, biomarkers, comparative effectiveness studies, and long-term real-world registries to support precision medicine and durable outcomes.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-evolving-therapeutic-paradigm-for-achieving-remission-in-crohns-disease-letter-to-the-editor/435707/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-evolving-therapeutic-paradigm-for-achieving-remission-in-crohns-disease-letter-to-the-editor/435707.png","ImageObject",300,407,{"name":92,"@type":93},"acoobca","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the primary objective of contemporary Crohn’s disease care mentioned in the letter?","Question",{"text":112,"@type":113},"To attain profound and sustained remission.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which treatments are highlighted as major steps in the evolving therapeutic landscape?",{"text":117,"@type":113},"Immunomodulators such as thiopurines and methotrexate, anti-TNF drugs, and newer selective agents including vedolizumab, ustekinumab, and anti–interleukin-23 therapies.",{"name":119,"@type":110,"acceptedAnswer":120},"What major evidence gaps does the letter emphasize for guiding treatment decisions?",{"text":121,"@type":113},"Contention about the role of traditional immunomodulators in the biologic era, limited head-to-head studies among newer biologics, and insufficient prognostic indicators to guide therapy selection.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},435707,1792170686,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},3985747870733,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Letter to the Editor  \nThe evolving therapeutic paradigm for achieving remission in Crohn’s disease  \nFNU Shahzaib, MBBSa , Arifa Arifa, BDSb , Haris Afridi, MBBSa , Raghabendra Kumar Mahato, MBBSc ,*  \nTo the Editor,  \nThe primary objective of contemporary Crohn’s disease (CD) care is to attain profound and sustained remission; yet, the therapeutic landscape is experiencing an unparalleled transformation. The growing range of treatments, which includes both classic immunomodulators and many new biologics and small compounds, offers both great prospects and difficult clinical problems. To get the best results for patients in this new age, we need to rethink how we treat them.  \nIn the past, immunomodulators like thiopurines and methotrexate were the key parts of steroid-sparing maintenance treatment. The introduction of anti-TNF drugs represented a paradigm change, showcasing enhanced potency in facilitating and sustaining mucosal repair. More recently, therapies with greater selectivity, like vedolizumab (an anti-integrin agent) and ustekinumab andrisankizumab (anti-interleukin-12/23 and anti-interleukin-23 agents, respectively), have improved our approach even more by giving us effective options with different safety profiles[1,2].  \nThe clinical ramifications are significant. This therapeutic diversification enables a more tailored approach, matching pharmacological mechanisms with the unique features of each patient and their condition. For patients, this means they are more likely to reach therapeutic goals beyond just controlling their symptoms, such as endoscopic remission, as stated in the STRIDE-II agreement[3] . For doctors, it complicates decisionmaking about the first-line biologic choice, the role of combination therapy vs monotherapy, and the best treatment sequencing following main or secondary non-response.  \nThe combination of anti-tumor necrosis factors (anti-TNFs) and immunomodulators, followed by anti-TNF monotherapy, showed a substantial effect size with intermediate confidence about the induction of clinical remission. More new treatments seem to have comparable impact sizes, but the estimations are less accurate[4].  \naDepartment of Medicine, Gujranwala Medical College, Gujranwala, Pakistan, bDepartment of Dentistry, Bolan Medical College Pakistan, Quetta, Pakistan and cDepartment of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal  \nSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara 33700, Nepal. Tel.: +977-9745829807. E-mail: [raghabendra.mahato2024@gmcthrc.edu](raghabendra.mahato2024@gmcthrc.edu)[ ](raghabendra.mahato2024@gmcthrc.edu)(R.K. Mahato).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons AttributionNon Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Annals of Medicine & Surgery (2026) 88:1074–1075  \nReceived 12 November 2025; Accepted 13 November 2025  \nPublished online 25 November 2025  \n[http://dx.doi.org/10.1097/MS9.0000000000004431](http://dx.doi.org/10.1097/MS9.0000000000004431)  \nEven with these improvements, there are still big gaps. The exact function of traditional immunomodulators in the contemporary biologic era is contentious – are they mainly supplementary to mitigate the immunogenicity of anti-TNF therapies, or is their significance waning? A lack of head-to-head studies comparing new biologics makes it hard to include them in treatment algorithms for sure. The most fundamental difficulty remains the paucity of good prognostic indicators to guide therapy, leaving tre","cbCairpxsMNgG6KT","https://ap.wps.com/l/cbCairpxsMNgG6KT","pdf",163283,"English","# Letter to the Editor\n## Therapeutic evolution toward remission\n## Clinical implications for treatment choice and sequencing\n## Evidence gaps and remaining controversies\n## Future directions: comparative studies, biomarkers, registries","[{\"question\":\"What is the primary objective of contemporary Crohn’s disease care mentioned in the letter?\",\"answer\":\"To attain profound and sustained remission.\"},{\"question\":\"Which treatments are highlighted as major steps in the evolving therapeutic landscape?\",\"answer\":\"Immunomodulators such as thiopurines and methotrexate, anti-TNF drugs, and newer selective agents including vedolizumab, ustekinumab, and anti–interleukin-23 therapies.\"},{\"question\":\"What major evidence gaps does the letter emphasize for guiding treatment decisions?\",\"answer\":\"Contention about the role of traditional immunomodulators in the biologic era, limited head-to-head studies among newer biologics, and insufficient prognostic indicators to guide therapy selection.\"}]","The evolving therapeutic paradigm for achieving remission in Crohn’s disease - Letter to the Editor | PDF",1790674865]