Condition

Crohn's Disease

Inflammatory bowel disease affecting the GI tract

1.9M
People Affected
15
Active Trials
38K
New Cases/Year
5,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Infliximab
75% Effectiveness• 90% Confidence• 40% Safety• 176 trials• 30K participants
HIGH EvidenceGood ValueDose: 5 mg/kg IV at weeks 0, 2, 6, then every 8 weeks
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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Morphine💊
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40
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

lifetime

Response Rate

65%

Remission Rate

40%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

30

Common Side Effects:

Infusion reactions: 15%
Upper respiratory tract infection: 25%
Headache: 15%
Serious infections: 4%
Malignancy (lymphoma, skin cancer): 0.5%

Annual Cost of Care

Drug Cost

$10,000

Monitoring

$1,150

Side Effects

$750

Total Annual

$11,900

Cost-Effectiveness

GOOD

QALYs Gained

0.08

ICER

$55,000/QALY

Cost per Remission

$29,750

Cost per Responder

$18,308

Treatment Outcomes
Primary Outcomes
Crohn's Disease Activity Index (CDAI)CDAI score: 280 (active severe Crohn's)
-39% (-110 points)
C-reactive Protein (CRP)25 mg/L (elevated)
-80% (-20 mg/L)
Simple Endoscopic Score for Crohn's Disease (SES-CD)SES-CD score: 9 (moderate-severe inflammation)
-67% (-6 points)
Fecal Calprotectin800 mcg/g (highly elevated)
-75% (-600 mcg/g)
Secondary Benefits
Inflammatory Bowel Disease Questionnaire (IBDQ) ScoreIBDQ total score: 130/224 (impaired quality of life)
+35% (+45 points)
Body Mass Index (BMI)19 kg/m^2 (underweight)
+10% (+1.9 kg/m^2)
Hemoglobin10.5 g/dL (mild anemia)
+14% (+1.5 g/dL)
Common Side Effects
Infusion reactions
+15%
Upper respiratory tract infection
+25%
Headache
+15%

Clinical Trial Phases:

Phase 3Phase 4
2
Adalimumab
75% Effectiveness• 90% Confidence• 45% Safety• 124 trials• 25K participants
HIGH EvidenceGood ValueDose: 160 mg SC at week 0, 80 mg SC at week 2, then 40 mg SC every other week
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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Morphine💊
Antibiotics💉
Tylenol💊
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45
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

lifetime

Response Rate

58%

Remission Rate

38%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

35

Common Side Effects:

Injection site reactions: 15%
Upper respiratory tract infection: 25%
Headache: 15%
Serious infections: 4%
Malignancy (lymphoma, skin cancer): 0.5%

Annual Cost of Care

Drug Cost

$12,000

Monitoring

$1,150

Side Effects

$750

Total Annual

$13,900

Cost-Effectiveness

GOOD

QALYs Gained

0.08

ICER

$60,000/QALY

Cost per Remission

$36,579

Cost per Responder

$23,966

Treatment Outcomes
Primary Outcomes
Crohn's Disease Activity Index (CDAI)CDAI Score: 280 (on a scale up to ~600)
-55% (-154 points)
C-Reactive Protein (CRP)CRP: 15 mg/L
-70% (-10.5 mg/L)
Fecal CalprotectinFecal Calprotectin: 750 µg/g
-80% (-600 µg/g)
Simple Endoscopic Score for Crohn's Disease (SES-CD)SES-CD Score: 10 (on a scale of 0-20+)
-60% (-6 points)
Secondary Benefits
Inflammatory Bowel Disease Questionnaire (IBDQ) ScoreIBDQ Score: 130 (out of 224)
+25% (+32.5 points)
Patient-Reported Abdominal PainAbdominal Pain Score: 6 (on a 0-10 numeric rating scale)
-55% (-3.3 points)
Corticosteroid Dosage (prednisone equivalent)Prednisone equivalent: 15 mg/day
-80% (-12 mg/day)
Common Side Effects
Injection site reactions
+15%
Upper respiratory tract infection
+25%
Headache
+15%

Clinical Trial Phases:

Phase 3Phase 4
3
Ustekinumab
72% Effectiveness• 88% Confidence• 50% Safety• 78 trials• 8K participants
HIGH EvidenceExcellent ValueDose: Initial IV dose based on weight (e.g., 260, 390, or 520mg), then 90 mg SC every 8 weeks
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
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Water💧
50
DangerousModerateSafe

Time to Effect

4-8 weeks

Duration

lifetime

Response Rate

55%

Remission Rate

30%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

75

Common Side Effects:

Nasopharyngitis: 12%
Headache: 12%
Injection site reactions: 4%
Fatigue: 7%
Serious infections: 3%

Annual Cost of Care

Drug Cost

$32,000

Monitoring

$1,150

Side Effects

$500

Total Annual

$33,650

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.07

ICER

$40,000/QALY

Cost per Remission

$112,167

Cost per Responder

$61,182

Treatment Outcomes
Primary Outcomes
Clinical Disease Activity Index (CDAI)280 points (CDAI)
-42.86% (-120 points)
Fecal Calprotectin1100 µg/g
-59.09% (-650 µg/g)
C-reactive protein (CRP)18 mg/L
-50% (-9 mg/L)
Endoscopic Score (SES-CD)16 points (SES-CD)
-56.25% (-9 points)
Secondary Benefits
Inflammatory Bowel Disease Questionnaire (IBDQ)135 points (IBDQ, range 32-224)
+22.22% (+30 points)
Abdominal Pain Score6.5/10 (NRS)
-46.15% (-3.0 points)
Stool Frequency5.5 stools/day
-45.45% (-2.5 stools/day)
Common Side Effects
Nasopharyngitis
+12%
Headache
+12%
Injection site reactions
+4%

Clinical Trial Phases:

Phase 3Phase 4
4
Vedolizumab
70% Effectiveness• 88% Confidence• 50% Safety• 95 trials• 6K participants
HIGH EvidencePoor ValueDose: 300 mg IV at weeks 0, 2, 6, then every 8 weeks
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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50
DangerousModerateSafe

Time to Effect

6-10 weeks

Duration

lifetime

Response Rate

45%

Remission Rate

25%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

75

Common Side Effects:

Nasopharyngitis: 15%
Headache: 12%
Arthralgia: 10%
Nausea: 8%
Serious infections: 3%

Annual Cost of Care

Drug Cost

$30,000

Monitoring

$1,150

Side Effects

$500

Total Annual

$31,650

Cost-Effectiveness

POOR

QALYs Gained

0.07

ICER

$150,000/QALY

Cost per Remission

$126,600

Cost per Responder

$70,333

Treatment Outcomes
Primary Outcomes
Crohn's Disease Activity Index (CDAI) ScoreCDAI Score: 280 (active moderate-severe disease)
-46.4% (-130 points)
C-Reactive Protein (CRP)25 mg/L (elevated)
-80% (-20 mg/L)
Simple Endoscopic Score for Crohn's Disease (SES-CD)SES-CD Score: 14 (moderate-severe disease)
-50% (-7 points)
Secondary Benefits
Fecal Calprotectin (FC)500 µg/g (elevated)
-60% (-300 µg/g)
Inflammatory Bowel Disease Quality of Life (IBD-QOL) ScoreIBD-QOL Score: 140 (out of 224, impaired)
+17.8% (+25 points)
Abdominal Pain Score (0-3 scale)2 (moderate)
-50% (-1 point)
Common Side Effects
Nasopharyngitis
+15%
Headache
+12%
Arthralgia
+10%

Clinical Trial Phases:

Phase 3Phase 4
5
Budesonide (controlled ileal release)
60% Effectiveness• 80% Confidence• 50% Safety• 30 trials• 4K participants
HIGH EvidenceExcellent ValueDose: 9 mg oral daily for 8 weeks, then taper
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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Morphine💊
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50
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

8-12 weeks

Response Rate

55%

Remission Rate

40%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

15

Common Side Effects:

Headache: 15%
Nausea: 8%
Acne: 7%
Adrenal suppression: 15%

Annual Cost of Care

Drug Cost

$750

Monitoring

$450

Side Effects

$100

Total Annual

$1,300

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.01

ICER

$15,000/QALY

Cost per Remission

$3,250

Cost per Responder

$2,364

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+60%
Response Rate
+55%
Remission Rate
+40%
Common Side Effects
Headache
+15%
Nausea
+8%
Acne
+7%

Clinical Trial Phases:

Phase 3Phase 4
6
Azathioprine / Mercaptopurine
58% Effectiveness• 80% Confidence• 30% Safety• 40 trials• 7K participants
HIGH EvidenceExcellent ValueDose: Azathioprine: 2-3 mg/kg daily; Mercaptopurine: 1-1.5 mg/kg daily
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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30
DangerousModerateSafe

Time to Effect

3-6 months

Duration

lifetime

Response Rate

55%

Remission Rate

38%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

25

Common Side Effects:

Nausea/vomiting: 15%
Myelosuppression: 8%
Hepatotoxicity: 8%
Pancreatitis: 4%
Increased lymphoma risk: 0.3%

Annual Cost of Care

Drug Cost

$250

Monitoring

$900

Side Effects

$300

Total Annual

$1,450

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.04

ICER

$10,000/QALY

Cost per Remission

$3,816

Cost per Responder

$2,636

Treatment Outcomes
Primary Outcomes
Crohn's Disease Activity Index (CDAI)280 (active disease, range 0-600)
-30% (-84 points)
C-reactive protein (CRP)15 mg/L (elevated)
-60% (-9 mg/L)
Fecal Calprotectin800 µg/g (elevated)
-75% (-600 µg/g)
Secondary Benefits
Inflammatory Bowel Disease Questionnaire (IBDQ) Score120 (impaired QoL, range 32-224)
+20% (+24 points)
Simple Endoscopic Score for Crohn's Disease (SES-CD)9 (moderate-severe inflammation, range 0-30+)
-50% (-4.5 points)
Body Weight58 kg (underweight due to disease)
+6.9% (+4 kg)
Common Side Effects
Nausea/vomiting
+15%
Myelosuppression
+8%
Hepatotoxicity
+8%

Clinical Trial Phases:

Phase 3Phase 4
7
Methotrexate
55% Effectiveness• 75% Confidence• 30% Safety• 24 trials• 5K participants
MODERATE EvidenceExcellent ValueDose: 15-25 mg weekly, oral or subcutaneous
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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Morphine💊
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Exercise🏃
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30
DangerousModerateSafe

Time to Effect

8-12 weeks

Duration

long-term

Response Rate

45%

Remission Rate

25%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

15

Common Side Effects:

Nausea/vomiting: 30%
Fatigue: 20%
Elevated liver enzymes: 15%
Myelosuppression: 7%
Teratogenicity: 100%

Annual Cost of Care

Drug Cost

$200

Monitoring

$850

Side Effects

$200

Total Annual

$1,250

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

ICER

$10,000/QALY

Cost per Remission

$5,000

Cost per Responder

$2,778

Treatment Outcomes
Primary Outcomes
CDAI Score280 points
-39.3% (-110 points)
C-Reactive Protein (CRP)18 mg/L
-35% (-6.3 mg/L)
Fecal Calprotectin800 µg/g
-40% (-320 µg/g)
Secondary Benefits
IBDQ Score150 points (range 32-224)
+12% (+18 points)
Average Daily Corticosteroid Dose15 mg/day Prednisone equivalent
-66.7% (-10 mg/day)
Number of Liquid/Soft Stools5 stools/day
-40% (-2 stools/day)
Common Side Effects
Nausea/vomiting
+30%
Fatigue
+20%
Elevated liver enzymes
+15%

Clinical Trial Phases:

Phase 3Phase 4