While efficacy is about equivalent, safety is better for VDZ/UST
Need to consider the efficacy and safety profile of COMBO therapy with anti-TNFs
Immunogenicity is highest for anti-TNFs
From real world EVOLVE-UC, it doesn't matter if we start or end at anti-TNF. So we CAN try non-TNFs first without worry.
Ustekinumab used first ⬆️⬆️⬆️⬆️QALYs
How to select first biologic:
Apart from ASUC and perianal CD, the efficacy of TNFs and non-TNFs are basically the same. The non-TNFs are safer. We don't lose efficacy of TNF if we start with non-TNF.
LFD studies are not great (small n, high bias, heterogeneity), but all the studies do suggest that the LFD is a good treatment option for #IBS and can improve global symptoms, pain, and bloating
App-based low-FODMAP #diet was found to be more effective (71%) than antispasmodic therapy (61%) in #IBS, even 6 months out