ECCO Topical Review on Optimisation of Therapy for Inflammatory Bowel Disease

Abstract Background: Advanced therapies have revolutionized inflammatory bowel disease (IBD) management, but primary non-response and secondary loss of response remain clinical challenges across all mechanisms of action. This topical review aims to offer evidence-based current practice positions for therapy optimization across all available advanced therapies. Methods: A panel of gastroenterologists performed a literature review on optimization of IBD advanced therapies (anti-tumour necrosis factor agents, vedolizumab, anti-IL-12/23 and anti-IL-23 agents, and small molecules) and formulated current practice positions that were approved in consensus. Conclusions: Strategies to reduce treatment failures, maximize drug persistence, and achieve optimal clinical benefit, including therapeutic drug monitoring and dose optimization, have become standard components of modern IBD care; however, this may vary according to the current evidence for each specific drug.