Breaking the therapeutic ceiling in drug development in ulcerative colitis

Advances in the intricate pathogenesis of ulcerative colitis (UC) have triggered a broad endeavour in drug development over the last two decades, resulting in the advent of several biological agents and small molecules.Although the increase in therapeutic options is a positive event, remission rates by new therapeutic agents in induction trials remain at a very modest 20-30%, and seemingly facing a socalled therapeutic ceiling.This situation requires a critical appraisal and highlights the need for alternative drug development strategies.We here objectively itemise the boundaries of therapeutic efficacy in UC, provide possible explanations for the shortcomings, and propose solutions to achieve better therapeutic outcomes in UC.