Shared Decision Making in Crohn’s Disease Management, With Jamie Brogan, NP

The treatment landscape for Crohn’s disease has expanded rapidly, most recently with the US Food and Drug Administration approvals of guselkumab (Tremfya) and mirikizumab (Omvoh), bringing new opportunities for improved outcomes but also greater complexity in clinical decision-making.

With more therapies available, clinicians must balance efficacy, safety, lifestyle considerations, and patient preferences to guide individualized care. At the 2025 Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) conference, Jamie Brogan, NP, a nurse practitioner at Northwestern Medicine, discussed positioning medications in Crohn’s disease in a treatment landscape she describes as both exciting and overwhelming.

“Choices increase the length of your discussion talking about different mechanisms of action, different routes of administration, different safety panels, and so this conversation with our patients in shared decision making gets longer and more complex, and sometimes increased options can increase confusion for patients,” Brogan told HCPLive. “I appreciate how exciting this is, but I also appreciate that this can complicate the conversation and extend it”

To streamline these discussions, Brogan emphasizes the value of decision aids like one-page comparison tools or online resources that help patients clearly weigh their options. In her view, patients who are engaged in understanding their disease and treatment choices often achieve better long-term outcomes.

While she says many of her patients have already begun advanced therapy before she sees them, Brogan says for those at the start, she sees it as an opportunity to both educate and reassure. These discussions are especially critical given Crohn’s disease often affects young adults facing lifelong treatment, underscoring the importance of aligning therapy with individual goals—such as study abroad, pregnancy planning, or career milestones—while balancing safety, efficacy, and lifestyle considerations.

“Healing is a priority, but the whole patient is really the priority, so bringing these parts of the human experience into the conversation is really important,” Brogan explained.

When therapies fail, she emphasizes the importance of carefully analyzing why. Factors such as coexisting autoimmune conditions, adverse effects like psoriasis from TNF inhibitors, comorbidities such as multiple sclerosis or heart failure, and disease severity all shape the next steps in treatment selection.

Ultimately, Brogan stresses that positioning medications in Crohn’s disease requires not only evidence-based knowledge but also a holistic, patient-centered approach that integrates the science of IBD management with the realities of patients’ lives.

References

1. Campbell P. FDA Approves Guselkumab (Tremfya) For Crohn Disease. HCPLive. March 20, 2025. Accessed September 10, 2025. https://www.hcplive.com/view/fda-approves-guselkumab-tremfya-for-crohn-disease

2. Brooks A. FDA Approves Mirikizumab (Omvoh) for Crohn’s Disease. HCPLive. January 15, 2025. Accessed September 10, 2025. https://www.hcplive.com/view/fda-approves-mirikizumab-omvoh-for-crohn-disease