PATHFINDER: Evaluating the Optimal First-Line Treatment Strategy for Moderate-to-Severely Active Ileal-dominant Crohn's Disease

Inclusion Criteria:

1. Male or nonpregnant, nonlactating females, 18 years of age or older. Females ofchildbearing potential must have a negative serum or urine pregnancy test prior torandomization

2. Established CD diagnosis by conventional criteria

3. Baseline colonoscopy within 3 months of the first day of the screening period, withphoto or video documentation of at least one large ileal ulcer >5 mm and ilealsegment SES-CD ≥4 (eligibility will be determined by local endoscopist, withsubsequent confirmation by a CR at a later time, post enrolment)

4. HBI ≥5

5. Biologic-treatment naïve for CD-related therapies

6. Would otherwise have been eligible to start a biologic for moderate-to-severelyactive CD as part of their routine clinical care and for whom there is equipoisearound which biologic class to start

7. Willing and able to participate fully in all aspects of this clinical trial,including adherence to study protocol and treatment algorithm

8. Written informed consent must be obtained and documented

Exclusion Criteria:

1. Condition(s) for which the biologics included in this study is contraindicated

2. CD-related complications such as symptomatic, endoscopically impassable stricturesor abscesses that require imminent surgery (at investigator's discretion)

3. Participants with current or history of colonic dysplasia or neoplasia, toxicmegacolon, or fulminant colitis

4. Recent bowel resection <3 months before screening

5. Active enteric infection (positive stool culture), including but not limited tobacterial (including C. difficile), viral, or parasitic enteric infections

6. Known active hepatitis B, hepatitis C, or human immunodeficiency virus infection

7. Active COVID-19 infection during the screening period

8. Tested positive as part of SOC for tuberculosis (TB) at screening by QuantiFERON® TBGold Test, tuberculin skin test, or history of untreated latent or active TB

9. History of malignancy within 5 years of screening, except fully treated carcinomain-situ of the cervix, fully treated and resolved nonmetastatic squamous or basalcell carcinoma of the skin

10. Active chronic or acute infections requiring treatment with systemic antibiotics,antivirals, antifungals, antiparasitics, or antiprotozoals during the screeningperiod

11. Serious underlying disease other than CD that, in the opinion of the investigator,may interfere with the participant's ability to participate fully in the study

12. Not willing to withhold protocol-prohibited medications during the trial, or plannedor anticipated use of any prohibited medications during screening

13. Received previously or currently receiving a TNF antagonist, anti-integrin,monoclonal antibody targeting IL-12/23 or IL-23, Janus kinase (JAK) inhibitors, orsphingosine 1 phosphate (S1P) receptor modulators (irrespective of indication)

14. History of alcohol or drug abuse that, in the opinion of the investigator, mayinterfere with the participant's ability to comply with the study procedures