Treatment sequencing in inflammatory bowel disease: Towards clinical precision medicine

Abstract

Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, raise ongoing challenges in clinical management due to their variable courses and impact on patient quality of life. The emergence of advanced therapies, from biologics to small molecules, has prompted the need for effective sequencing strategies to optimize patient outcomes. To this date, there is no algorithm for treatment sequencing and physicians must select the safest and most effective treatment according to each individual patient. This review aims to explore the latest insights in treatment sequencing according to multiple criteria, such as prior use of anti-TNF alpha agents, prior surgery, disease phenotype and location, but also patient characteristics, such as age or history of malignancy. Treatment sequencing in IBD should be part of a clinical medicine approach and be tailored to individual patient characteristics, disease severity, and therapeutic response history. Indeed, a personalized approach of therapeutic management in inflammatory bowel diseases can improve long-term outcomes and quality of life. Ongoing research is essential to refine sequencing strategies, and better incorporate these advances into clinical practice.

Keywords: Advanced therapies; Crohn's disease; Sequencing; Ulcerative colitis.