How would you manage active non-stricturing, non-fistulizing moderate ileal Crohn’s disease in patients on Natalizumab with well-managed multiple sclerosis?   

I would be hesitant to add a second immunosuppressing medication to natalizumab. I might consider vedolizumab given a favorable safety profile (even though evidence suggests it is less effective for ileal disease) or talk with a Neurologist about switching from NAT to another drug for MS that might ...

I would check natalizumab trough level. If below 2 ng/ml, I would raise the dose; if above 2 ng/ml, I would add an anti-IL23.