What are the current first-line treatments for managing active Crohn's

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

The current first-line treatments for managing active Crohn's disease in adults include:

Offer monotherapy with a conventional glucocorticosteroid (such as prednisolone, methylprednisolone, or intravenous hydrocortisone) to induce remission in people with a first presentation or a single inflammatory exacerbation of Crohn's disease in a 12‑month period .
Consider adding methotrexate to a conventional glucocorticosteroid or budesonide to induce remission if the person cannot tolerate azathioprine or mercaptopurine, or if TPMT activity is deficient .
In cases of severe active Crohn's disease, infliximab or adalimumab may be used if conventional therapy has not responded or is not tolerated, given as a planned course until treatment failure or 12 months, with reassessment for ongoing treatment .

What are the current first-line treatments for managing active Crohn's disease in adults?