How to Choose the Biologic Therapy in a Bio-naïve Patient with Inflammatory Bowel Disease

J Clin Med. 2022 Feb 4;11(3):829. doi: 10.3390/jcm11030829.

Viviana Laredo 1, Carla J Gargallo-Puyuelo 1 2, Fernando Gomollón 1 2 3 4


Author information

1Department of Gastroenterology, University Clinic Hospital Lozano Blesa, 50009 Zaragoza, Spain.

2Institute for Health Research Aragón (IIS Aragón), 50009 Zaragoza, Spain.

3Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, 50009 Zaragoza, Spain.

4Liver and Digestive Diseases Networking Biomedical Research Centre (Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, CIBEREHD), 28029 Madrid, Spain.


The availability of biologic therapies in inflammatory bowel disease (IBD) is increasing significantly. This represents more options to treat patients, but also more difficulties in choosing the therapies, especially in the context of bio-naïve patients. Most evidence of safety and efficacy came from clinical trials comparing biologics with placebo, with a lack of head-to-head studies. Network meta-analysis of biologics and real-world studies have been developed to solve this problem. Despite the results of these studies, there are also other important factors to consider before choosing the biologic, such as patient preferences, comorbidities, genetics, and inflammatory markers. Given that resources are limited, another important aspect is the cost of biologic therapy, since biosimilars are widely available and have been demonstrated to be effective with a significant decrease in costs. In this review, we summarize the evidence comparing biologic therapy in both Crohn´s disease (CD) and ulcerative colitis (UC) in different clinical situations. We also briefly synthesize the evidence related to predictors of biologic response, as well as the biologic use in extraintestinal manifestations and the importance of the drug-related costs.

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