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The following is a summary of “Treatment Sequencing in Inflammatory Bowel Disease: Towards Clinical Precision Medicine,” published in the March 2025 issue of Best Practice & Research Clinical Gastroenterology by Sequier et al.

Inflammatory bowel diseases (IBD), encompassing Crohn’s disease and ulcerative colitis, present significant challenges in clinical management due to their heterogeneous disease courses, variable therapeutic responses, and profound impact on patient quality of life. The advent of advanced therapeutic options, including biologics and small-molecule inhibitors, has expanded treatment possibilities but has also introduced complexities in determining the optimal sequencing of these therapies. 

Currently, no standardized algorithm exists for treatment sequencing in IBD, necessitating an individualized approach where physicians must weigh efficacy, safety, and patient-specific factors when making therapeutic decisions. This review aims to provide a comprehensive analysis of current evidence and emerging strategies for treatment sequencing in IBD, incorporating key clinical variables such as prior exposure to anti-TNF-α agents, history of surgical intervention, disease phenotype, anatomical disease location, and individual patient characteristics, including age and history of malignancy. 

Given the progressive nature of IBD, therapeutic sequencing should be integrated into a personalized medicine framework that accounts for disease severity, treatment response history, and evolving patient needs. A tailored, patient-centered approach to sequencing therapies can significantly enhance long-term disease control, reduce complications, and improve overall quality of life. Furthermore, continued research is essential to refine sequencing paradigms and to better integrate novel therapeutics into evidence-based clinical practice. As precision medicine advances, a more structured, individualized approach to treatment sequencing will be critical in optimizing outcomes for patients with IBD.

Source: sciencedirect.com/science/article/abs/pii/S1521691825000216