Background: Despite the availability of various advanced treatments for inflammatory bowel disease (IBD), it has been impossible to predict which therapy would offer the best response to the patient. Objective: The aim of this systematic review is to explore current and novel biomarkers for predicting and assessing therapeutic response to advanced therapies presently in clinical use in IBD. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO ID: CRD42024559652). A systematic literature search for all primary research looking at biomarkers in predicting response to advanced therapy in Crohn's disease (CD) or ulcerative colitis (UC) was conducted across MEDLINE, EMBASE and PubMed databases. Abstracts, case studies, commentary papers and review articles were excluded. Results: Fifty-five studies were included in this review investigating baseline predictors of response to anti-tumour necrosis factor, ustekinumab, vedolizumab and ozanimod therapies in both CD and UC. The various biomarkers studied included blood, serum, faecal, histological, nutrient, genetic and pharmacokinetic markers. C-reactive protein and faecal calprotectin were among the most commonly studied biomarkers; however, there were inconsistencies with regard to optimum cutoff values used and hence their roles as baseline predictors of response to advanced therapies are yet unclear. None of the biomarker studies to date has yet transitioned to clinical use. Conclusion: Biomarker identification to predict therapeutic response persists to be an ongoing challenge. Further work through large well-designed prospective cohort studies is needed to further refine the clinical utility of these tools. Trial registration: .
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Radford et al. (2026) studied this question.
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