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Original Article

Real-world use and perceptions of advanced combined therapies in treating inflammatory bowel disease: Hsin-Yun Wu, Zhi-Che Chen, Meng-Tzu Weng, Agnes Hiu Yan Ho, Joyce Wing Yan Mak, Rupert W Leong, Siew-Chien Ng, Uma Mahadevan, Fernando Magro, Deng-Chyang Wu, Shu-Chen Wei; Received December 18, 2025 Accepted March 17, 2026 Published online May 19, 2026; DOI: https://doi.org/10.5217/ir.2025.00325 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Combining therapies targeting distinct pathways shows promise in breaking the therapeutic ceiling for inflammatory bowel disease. The study explored real-world experiences and gaps between current evidence and clinical practice regarding advanced combined therapies.
Methods
A cross-sectional online survey was conducted via QR code during meetings or email invitation. The survey covered participant demographics, experiences with advanced combined therapies for ulcerative colitis, Crohn’s disease, and knowledge of these therapies.
Results
Between March and October of 2024, 234 participants from 20 countries replied and 51.7% had adopted advanced combined therapies (86.0% had treated ulcerative colitis, 66.9% Crohn’s disease, and 52.9% both). Among the 48.3% who had no experience, 76.1% would try if indicated. Refractory diseases were the most common indications. For combined therapies duration, 52.8% were time-oriented, favoring limited use within 6 months. Physicians reported no adverse events in 59.5% of cases. Of the events, infections (69.8%) were most common. Add-on strategy was the most commonly adopted, particularly the Janus kinase inhibitor added on anti-integrin for ulcerative colitis and anti-tumor necrosis factor alpha added on anti-interleukin 12/23 for Crohn’s disease. Concomitant strategy followed, while sequential strategy was the least used. More non-Asian experts were experienced (82.4%) compared to Asian participants (46.5%). Both inexperienced and non-Asian physicians preferred add-on strategy, but prioritized goal-oriented use, targeting clinical and endoscopic remission.
Conclusions
In real-world practice, advanced combined therapies were primarily used for refractory inflammatory bowel disease with limited duration. Add-on use was the most adopted. Differences in treatment approaches reflect varying levels of physician experience and geographical locations.

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Review

IBD

Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition: Filiz Akyüz, Yoon Kyo An, Jakob Begun, Satimai Aniwan, Huu Hoang Bui, Webber Chan, Chang Hwan Choi, Nazeer Chopdat, Susan J Connor, Devendra Desai, Emma Flanagan, Taku Kobayashi, Allen Yu-Hung Lai, Rupert W Leong, Alex Hwong-Ruey Leow, Wai Keung Leung, Julajak Limsrivilai, Virly Nanda Muzellina, Kiran Peddi, Zhihua Ran, Shu Chen Wei, Jose Sollano, Michelle Mui Hian Teo, Kaichun Wu, Byong Duk Ye, Choon Jin Ooi; Intest Res 2025;23(1):37-55. Published online November 4, 2024; DOI: https://doi.org/10.5217/ir.2024.00089

Abstract PDF PubReader ePub

The lack of clear definition and classification for “moderate ulcerative colitis (UC)” creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

Citations

Citations to this article as recorded by

CU104, a novel barrier function enhancer, improves colitis via modulation of barrier function and immune cell recruitment
I Seul Park, Ji Hyung Kim, Dongyeop Kim, Ye Won Kim, Yoojin Shin, Ki Beom Kim, Haiying Zhang, Tae Il Kim, Seung Won Kim, Young-Guen Kwon, Jae Hee Cheon
Frontiers in Immunology.2026;[Epub] CrossRef
Dosing 5-ASA for Ulcerative Colitis: Is the Maximum Optimum?
Nai-Yu Chen, Chiao-Hsiung Chuang
Digestive Diseases and Sciences.2026;[Epub] CrossRef
Therapeutic Promise of the Panax Genus in Ulcerative Colitis: Unraveling the Multitarget Mechanisms of Saponins and Polysaccharides
Cailan Li, Yi Zhou, Yuanqi Jiao, Xingfang Qian, Xuefei Wang, Haohui Chen, Luyou Zhao, Han Zhang, Qiang Lu
Journal of Agricultural and Food Chemistry.2026; 74(16): 12569. CrossRef
Oral Colon-Targeted Lipid Nanoparticles Enhance Upadacitinib Delivery and Efficacy in a Murine Model of Ulcerative Colitis
Rabeya Jafrin Mow, Xiaodi Shi, Wen Lu, Siming Wang, Didier Merlin, Chunhua Yang
International Journal of Molecular Sciences.2026; 27(9): 3758. CrossRef
Sex-specific differences in the efficacy and prognosis of 5-aminosalicylic acid therapy for ulcerative colitis: A 20-year retrospective cohort study
Zhao-Shi Liu, Hao Tang, Hui-Min Zhang, Xiao-Yin Bai, Hong Yang, Xiao-Feng Li, Jia-Ming Qian
World Journal of Gastroenterology.2026;[Epub] CrossRef
Patient-Derived Claims Data on 5-ASA Utilization in Ulcerative Colitis: Strengths, Limitations, and Future Directions
Xiaochen Fu, Dan Wang
Digestive Diseases and Sciences.2026;[Epub] CrossRef
Inflammatory bowel disease in Africa: the current landscape of pharmacological treatments and the promise of emerging innovations
Murtada A. Oshi
Exploration of Drug Science.2025;[Epub] CrossRef

26,976 View
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7 Web of Science
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Original Article

IBD

The association between new generation oral contraceptive pill and the development of inflammatory bowel diseases: Santosh Sanagapalli, Yanna Ko, Viraj Kariyawasam, Siew C Ng, Whitney Tang, Hithanadura Janaka de Silva, Minhu Chen, Kaichun Wu, Satimai Aniwan, Ka Kei Ng, David Ong, Qin Ouyang, Ida Hilmi, Marcellus Simadibrata, Pises Pisespongsa, Saranya Gopikrishna, Rupert W Leong; Intest Res 2018;16(3):409-415. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.409

Abstract PDF PubReader ePub

<b>Background/Aims</b><br/>

To examine the association between use of oral contraceptive pills (OCPs) and the risk of developing inflammatory bowel diseases (IBD), in a modern cohort.

Methods

A prospective nested case-control study across sites in the Asia-Pacific region was conducted; involving female IBD cases and asymptomatic controls. Subjects completed a questionnaire addressing questions related to OCP use. Primary outcome was the risk of development of IBD of those exposed to OCP versus non-exposure. Secondary outcomes were development of Crohn's disease (CD) versus ulcerative colitis (UC), and whether age of first use of OCP use may be associated with risk of IBD.

Results

Three hundred and forty-eight female IBD cases (41% CD, median age: 43 years) and 590 female age-matched controls were recruited. No significant association was found between OCP use and the risk of IBD (odds ratio [OR], 1.65; 95% confidence interval, 0.77–3.13; P=0.22), CD (OR, 1.55) or UC (OR, 1.01). The lack of association persisted when results were adjusted for age and smoking. IBD cases commenced OCP use at a younger age than controls (18 years vs. 20 years, P=0.049).

Conclusions

In this large cohort of subjects from the Asia-Pacific region, we found a modest but not significantly increased risk of developing IBD amongst OCP users.

Citations

Citations to this article as recorded by

Sex-related differences in profiles and clinical outcomes of Inflammatory bowel disease: a systematic review and meta-analysis
Dana A. Salem, Rawan El-Ijla, Razan R. AbuMusameh, Khaled A. Zakout, Alaa Y. Abu Halima, Mohammed T. Abudiab, Yahya M. Banat, Basel F. Alqeeq, Mohammed Al-Tawil, Khaled Matar
BMC Gastroenterology.2024;[Epub] CrossRef
Estrogen receptor actions in colitis
Erika L. Garcia-Villatoro, Clinton D. Allred
Essays in Biochemistry.2021; 65(6): 1003. CrossRef
Sex-based differences in inflammatory bowel diseases: a review
Sheila D. Rustgi, Maia Kayal, Shailja C. Shah
Therapeutic Advances in Gastroenterology.2020;[Epub] CrossRef

13,067 View
110 Download
4 Web of Science
3 Crossref

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