Combining Therapies in Inflammatory Bowel Disease: End of the Line or a New Era?

Medical therapies for inflammatory bowel disease (IBD) have evolved dramatically in recent decades. Despite this evolution, rates of treatment failure and surgery remain high.1 At least half of patients with Crohn’s disease (CD) will undergo surgery during their lifetime, whereas up to 15% of patients with ulcerative colitis (UC) require colectomy within 20 years of diagnosis.2, 3 Combining agents targeting different steps in the inflammation has the theoretical potential to produce synergistic effects, potentially reducing the risk of treatment failure or providing enhanced coverage of the extraintestinal manifestations (EIMs) of IBD. Concerns over increased costs, infection rates, and adverse events have limited the adoption of such a strategy. Though recent studies have suggested safety and efficacy, there remain very few data on the combination of biologic and nonbiologic agents in IBD, particularly in ulcerative colitis.4, 5 We aimed to provide real-world data on the safety...