2a. In adult outpatients with moderate-severe ulcerative colitis who are naïve to biologic agents, the AGA suggests using infliximab or vedolizumab rather than adalimumab, for induction of remission. (Conditional recommendation, moderate quality evidence)

Comment: Patients, particularly those with less severe disease, who place higher value on the convenience of self-administered subcutaneous injection, and a lower value on the relative efficacy of medications, may reasonably chose adalimumab as an alternative.

2b. In adult outpatients with moderate-severe ulcerative colitis who are naïve to biologic agents, the AGA recommends that tofacitinib only be used in the setting of a clinical or registry study. (No recommendation, knowledge gap) Comment: Updated FDA recommendations (07/26/2019) on indications for use of tofacitinib in ulcerative colitis recommends its use only after failure of, or intolerance to TNFα antagonists.