IBD Matchmaking: Rational Combination Therapy

A growing number of patients with Crohn's disease and ulcerative colitis have disease that is refractory to multiple advanced therapies, have undergone multiple surgeries and require further treatment options. For this reason, there has been increasing use of multiple simultaneous advanced targeted therapies. While knowledge on combined advanced targeted therapy (CATT) in inflammatory bowel disease has been largely limited to observational data and early phase randomized controlled trials, combination of therapies is commonplace in many other diseases. This review discusses conceptual frameworks of CATT in inflammatory bowel disease (IBD), provides context of combined therapies in other diseases, provides current evidence for CATT in IBD, and projects future applications and positioning of CATT using existing, novel, and orthogonal mechanisms of action. CATT aims to address the need to overcome low efficacy rates and frequent loss of response of current individual therapies. Both treatment exposure and disease duration are major determinants of response to therapy. Identification of safe and effective CATT may impact positioning of this strategy to apply to a broader IBD population.