1. Agree completely
2. Agree with minor reservations
3. Agree with major reservations
4. Reject with reservations
5. Reject completely

Statement Rationale and Definition

Crohn’s disease (CD) is a chronic progressive disease.¹ Treatment at diagnosis or at the time of disease flare includes an induction phase to help patients improve by eliciting a response to therapy with symptom control, and then, more importantly, a maintenance phase to keep these patients in clinical remission long-term. Treatment goals have evolved to include complete resolution of symptoms, normalization of laboratory parameters, and mucosal healing.² Most patients who ultimately require biologic therapy have been previously exposed to immunomodulator (IMM) therapy (ie, the purine antimetabolites azathioprine [AZA] or 6-mercaptopurine [MP] or the antimetabolite methotrexate [MTX]), although the treatment failed.^{3, 4} Despite the emerging evidence supporting early combination therapy for CD, only a few patients start a biologic and an IMM concomitantly.^{5, 6} Once remission has been achieved, the desire of both physicians and patients is to de-escalate therapy, an approach that includes discontinuing treatment with the anti-tumor necrosis factor-α (anti-TNF) agent, or the IMM, or both;^{7, 8} treatment withdrawal is predominantly driven over concerns of safety and cost.⁷