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 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.

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