Why do we need to improve monitoring of patients with inflammatory bowel disease (IBD) on biologic treatment?

Introduction: Treatment goals for IBD patients traditionally focused on symptom control. It is increasingly recognized that many patients have continued disease activity without symptoms. Subclinical inflammation increases the risk of disease flares and long-term complications. A consensus is therefore emerging on the need to treat beyond symptoms and to define clear treatment targets for IBD patients receiving biologic medicines. Areas covered: We review validated tools used in IBD for monitoring clinical and endoscopic response to therapy. We discuss the value of using non-invasive tests in assessing disease activity. We summarise the latest guidelines in IBD treatment and review recommendations regarding therapeutic drug monitoring. We examine the role of monitoring for and prevention of avoidable complications of treatment. Expert Opinion: The goals of treatment in IBD are to achieve both clinical remission and mucosal healing. Whether we adopt a top-down or more conventional treatment strategy there is now an imperative to monitor patients using a combination of endoscopic and biochemical markers to assess the degree of continuing inflammation and establish early disease control. TDM has facilitated huge improvement in the ability to personalize delivery of biologics. This has allowed for early detection and prevention of loss of response.