Positioning and sequencing of advanced therapies in inflammatory bowel disease: A guide for clinical practice

Table 1 Timeframe for assessing therapeutic effectiveness in inflammatory bowel disease and associated dosing regimens

Classe of drugs	Therapeutic regimens and timeframes
Aminosalicylates (mesalazine and sulfasalazine only for mild to moderate UC)	Maximum dosing orally (4.8 g/day) combined with topical therapy for 2-4 weeks
Steroids (budesonide, prednisone, hydrocortisone)	(1) Budesonide 9 mg/day for 2 weeks; (2) Prednisone 40 mg/day PO for 2 weeks; and (3) Hydrocortisone (300-400 mg/day) or methylprednisolone (60 mg/day) IV during 3-5 days in acute severe UC
Immunosuppressant (methotrexate and thiopurines)	(1) Methotrexate 25 mg/week IM or SC for 4-6 weeks (only for CD); and (2) Thiopurines 2.0-2.5 mg/kg daily PO for 12-16 weeks (only for maintenance of remission)
Anti-TNF (infliximab, adalimumab, certolizumab pegol and golimumab)	After 2 (adalimumab, golimumab) or 3 (infliximab, certolizumab pegol) loading doses and first maintenance dose, may include proactive TDM
Anti-integrin (vedolizumab)	After 3 Loading doses and 1-3 maintenance doses
Anti-IL-12/23 (ustekinumab); Anti-IL-23p19 (risankizumab, guselkumab and mirikizumab)	After 3 Loading doses and 1-3 maintenance doses
S1P receptor modulators (ozanimod and etrasimod)	(1) Ozanimod 0.92 mg/day for 10 weeks; and (2) Etrasimod 2 mg orally once a day for 12 weeks
Janus kinase inhibitors (tofacitinib and upadacitinib)	(1) Tofacitinib 10 mg orally twice daily for 8-16 weeks; and (2) Upadacitinib 45 mg orally once a day for 8-16 weeks (UC) or upadacitinib 45 mg orally once a day for 12 weeks (CD)

UC: Ulcerative colitis; TNF: Tumoral necrosis factor; S1P: Sphingosine 1-phosphate; IL: Interleukin; PO: Per oral; IV: Intravenous; IM: Intramuscularly; SC: Subcutaneous; CD: Crohn's disease; TDM: Therapeutic drug monitoring.