Has the time come for a systematic top-down approach in Crohn's disease?

Risk stratification and choosing the best treatment for individual patients—ie, personalised medicine—is a major unmet need in inflammatory bowel disease (IBD). Although several studies have suggested that clinical outcomes can be improved with the use of early advanced therapy,1–3 accurately identifying which patients could benefit from early intervention remains a key point. Implementing a strategy using the most effective drugs for all patients would potentially lead to overtreatment of some patients with milder disease, with subsequent extraneous costs for health-care systems and unnecessary risks of adverse events.