Abstract INTRODUCTION Despite advances in biologic therapies for IBD, the optimal timing for initiating treatment remains debated. Traditional step-up approaches may delay effective disease control. This meta-analysis evaluates whether earlier biologic use alters real-world outcomes in IBD, including remission, hospitalizations, corticosteroid dependence, and surgical risk. This study aimed to determine the comparative effectiveness of early versus late biologic therapy initiation in IBD using real-world clinical endpoints. METHODS Following PRISMA guidelines, we searched PubMed, Cochrane Library, ClinicalTrials.gov, PLOS ONE, and Google Scholar for studies from the past 25 years. Included studies compared early versus delayed biologic therapy in adults with Crohn’s disease or ulcerative colitis. Four eligible studies (n = 2,168) were included. Risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic. RESULTS • Hospitalization: Early therapy reduced risk by 37% (RR 0.63; 95% CI: 0.49–0.81; I2 = 21%). • Corticosteroid Use: 44% reduction in dependence (RR 0.56; 95% CI: 0.41–0.75; I2 = 18%). • IBD-related Surgery: Risk halved (RR 0.51; 95% CI: 0.35–0.75; I2 = 0%). • Clinical Remission: Modestly favored early therapy (RR 1.24; 95% CI: 0.92–1.67; I2 = 27%) without reaching statistical significance. • Adverse Events: Comparable between early and late groups (RR 1.08; 95% CI: 0.88–1.33). CONCLUSION Early biologic initiation in IBD significantly reduces hospitalization, steroid use, and surgery without increasing adverse events. These findings advocate for a proactive treatment paradigm, particularly in patients with moderate-to-severe disease phenotypes. Future prospective studies should confirm whether early initiation translates to sustained remission and improved quality of life.
Shah-Riar et al. (2026) studied this question.