DOP124Therapy optimisation in inflammatory bowel disease: An ECCO topical review across biologics and small molecules

Abstract Background Despite the expanding therapeutic armamentarium for inflammatory bowel disease (IBD), a significant proportion of patients experience suboptimal response, loss of response (LOR), or treatment-limiting side effects. Therapy optimisation is increasingly recognised as a key strategy to enhance treatment efficacy, durability, and safety. The ECCO topical review on therapy optimisation aimed to provide evidence-based and expert-driven guidance on optimising currently available IBD therapies, including anti-TNFs, anti-integrins, anti-IL-23 agents, and small molecules. Methods An expert multidisciplinary panel divided into four working groups (WGs) conducted a comprehensive review of the literature on pharmacokinetics, therapeutic drug monitoring (TDM), dose intensification, immunogenicity, and predictors of response to optimised treatment. Evidence was appraised through systematic searches and structured discussions. Consensus statements were generated using PICO methodology, and recommendations were developed through iterative group consensus. Results Thirty-five statements were formulated across therapeutic classes. For anti-TNF agents, higher trough levels during induction and maintenance were associated with improved outcomes; proactive TDM and short-term combination with immunomodulators were recommended strategies to mitigate immunogenicity. For vedolizumab, interval shortening may recapture response, while combination with immunomodulators provided no consistent benefit. For ustekinumab and risankizumab, extended induction and interval shortening were viable options in selected patients with partial response or LOR. For small molecules, upadacitinib and tofacitinib dose intensification showed promise in ulcerative colitis (UC), though data for Crohn’s disease (CD) remain limited. Safety signals across dose-optimised strategies were generally comparable to standard dosing. Conclusion Therapy optimisation in IBD, through proactive monitoring and personalised dose adjustment, holds promise for improving patient outcomes and drug durability. This ECCO topical review offers structured, agent-specific guidance to support therapeutic decision-making across a spectrum of biologics and small molecules in both UC and CD. Conflict of interest: Queiroz, Natalia: Personal Fees: NSFQ has served as a speaker and advisory board member of Janssen, Takeda and Abbvie. Barreiro-de-Acosta, Manuel: MBA has been speaker, consultant and advisory member for or has received research funding from MSD, AbbVie, Janssen, Kern Pharma, Celltrion, Takeda, Alphasigma, Lilly, Pfizer, Sandoz, Biocon, Abivax, Fresenius, Faes Farma, Ferring, Tillots, Chiesi, Adacyte, Diasorin, Oncostellae and SunRock. D’Amico, Ferdinando: Grant: ECCO fellowship grant 2020 ECCO grant 2021 Personal Fees: F D’Amico has served as a speaker for Abbvie, Alfasigma, Ferring, Lilly, Sandoz, Janssen, Fresenius Kabi, Galapagos, Giuliani, MSD, Pfizer, Takeda, Tillotts, and Omega Pharma he also served as an advisory board member for Abbvie, AnaptysBio, Ferring, Fresenius Kabi, Galapagos, Janssen, Lilly, MSD, Takeda, and Nestlè. Katsanos, Konstantinos: AbbVie, Amgen, Athos, Αenorasis, Biocon,Biogaia, Drugssales Ltd, Epsilon Health, Falk, Faran, Ferring, Genesis, Grifols S.A., Hospital line, Johnson & Johnson, COPER, MSD, Biocon, Pfizer, Potamitis Medicare, Rafarm, Petsiavas, Shire,Takeda, Vianex, Lilly Lobatón Ortega, Triana: Grant: Abbvie, Ferring, Viatris, MSD, EG, Mundipharma, Biogen, Janssen, Pfizer, Takeda, Galapagos, Afasigma and Sandoz. Personal Fees: Speaker fees from MSD, Abbvie, Janssen, Amgen, Fresenius Kabi, Galapagos, Viatris, Ferring, Celltrion, Alfasigma, Lilly and Takeda. Consultancy fee from Janssen, Galapagos, Alfasigma, Amgen, Bristol Myers, Squibb Fresenius Kabi, Takeda and Abbvie Plevris, Nikolas: Speaker fees / travel support from Abbvie, Pfizer, Janssen, Lilly, Ferring Rodríguez-Lago, Iago: Financial support for traveling and educational activities from or has served as an advisory board member for Abbvie, Adacyte, Alfasigma, Biogen, Chiesi, Faes Farma, Ferring, Fresenius Kabi, Galapagos, Johnson & Johnson, Eli Lilly, Mirum Pharmaceuticals, Merck, Pfizer, Roche, Takeda, and Tillotts Pharma. Research support from AbbVie Ungar, Bella: Bella Ungar has recieved lecture fees / consultation fees from Ely Lilly, Abbvie, Takeda, Padagis Yanai, Henit: Grant: Pfizer, ISF Personal Fees: AbbVie, Janssen, Pfizer, Takeda, Bristol Myers Squibb, and Elly Lilli. Parra Izquierdo, Leidy Viviana: No conflict of interest Hanzel, Jurij: Speaker’s fees from Abbvie, Eli Lilly, Janssen, and Takeda, and consulting fees from Alimentiv Inc and Janssen Ernest-Suárez, Kenneth: Consulting/Advisory Board fees: Abbvie, AstraZeneca, Johnson & Johnson, Pfizer, Ferring, Sandoz, SatisfAI, Takeda Krznarić, Željko: Speakers honoraria (Abbott, Abbvie, Biocon, Celltrion/ Octal Pharma, Fresenius, Eli Lilly, Pharmas, Pfizer, Sobi, Takeda, Nestle, Nutricia, Baxter, Janssen, MSD). Advisory boards Tavares de Sousa, Helena: Takeda, AbbVie, Janssen, Pfizer, Ferring, Biogen, Lilly - for presenting or advisory board Non-financial Support: Abbvie, Takeda, Janssen, Ferring, Faez Pharma, Tillots, Falk Pharma Kopylov, Uri: Grant: Takeda, Janssen,Abbvie, Medtronic, Ely Lilly Other: Takeda, Janssen, Ely Lilly, Roche, Celtrion, Abbvie, Medtronic, CTS, Pfizer, BMS- speaker and advisory fees