IBD Management Requires Objective Monitoring, Advanced Therapy Selection
Inflammatory bowel disease (IBD) management should aim to alter the disease course rather than focus solely on symptom improvement, according to David Fudman, MD, who discussed treatment selection, therapeutic drug monitoring (TDM), and combination strategies during his session, “Gastrointestinal Disease and the Skin,” presented at the Masterclasses in Dermatology NP/PA Institute.
Dr Fudman reviewed approaches to early IBD diagnosis and treatment, including the selection and dosing of advanced therapies and the role of TDM, particularly for anti-tumor necrosis factor (aTNF) therapy. He also compared advanced therapy dosing in IBD and dermatology and introduced strategies for combining advanced treatments.
“Therapy in IBD aims to not just improve symptoms but to alter natural history,” Dr Fudman emphasized.
Achieving that goal requires continued assessment beyond patients’ reported symptoms. Serial objective evaluations are needed to determine treatment response and should continue during periods of clinical remission.
Most patients with IBD have a moderate or severe risk of disease progression and require advanced therapy, according to Dr Fudman. In contrast, a minority of patients with both mild disease severity and mild disease activity may be managed without advanced treatment.
TDM can help clinicians make decisions when response to aTNF therapy is inadequate. “Use reactive TDM before giving up on an aTNF and to inform the next drug,” Dr Fudman advised.
Proactive TDM may also help prevent aTNF immunogenicity and guide treatment de-escalation. Higher therapeutic targets may warrant consideration in patients with hidradenitis suppurativa.
Lastly, Dr Fudman highlighted the emerging role of combining advanced therapies, particularly for patients affected by more than 1 immune-mediated inflammatory disease.
Reference
Fudman D. Gastrointestinal disease and the skin. Presented at: Masterclasses in Dermatology NP/PA Institute; October 17–18, 2026; Dallas, TX.
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