Concomitant use of immunosuppressive therapy with tumor necrosis factor (TNF) antagonists in inflammatory bowel disease

The treatment paradigm of ulcerative colitis (UC) and Crohn’s disease (CD) has shifted considerably over the past decade. Despite the advancements in our understanding of treatment monitoring and optimization, one of the key questions that continues to be debated is the optimal approach to using concomitant immunosuppressive agents. Well-designed randomized controlled trials have suggested that a clear treatment benefit exists; however, the external validity and applicability of these findings to the general population, and the personalization of treatment decisions based on individual factors and safety, remain to be clarified. In this review, we will discuss the evidence available for treatment efficacy, the impact safety may have on treatment decisions, and opportunities available to optimize the potential application and personalization of concomitant immunosuppressive therapy.