Biological therapies have become the standard treatment for ulcerative colitis (UC).
However, clinical remission rates post-induction therapy remain modest at 40-50%,
with many initial responders losing response over time. Current treatment strategies
frequently rely on a 'trial and error' approach, leading to prolonged periods of ineffective
and costly therapies for patients, accompanied by associated treatment complications.This
review discusses current evidence on risk stratification tools for predicting therapeutic
efficacy and minimizing adverse events in UC management. Recent studies have identified
predictive factors for biologic therapy response. In the context of personalized medicine,
the goal is to identify patients at high risk of progression and complications, as
well as those likely to respond to specific therapies. Essential risk stratification
tools include clinical decision-making aids, biomarkers, genomics, multi-omics factors,
endoscopic, imaging, and histological assessments.Employing risk stratification tools
to predict therapeutic response and prevent treatment-related complications is essential
for precision medicine in the biological management of UC. These tools are necessary
to select the most suitable treatment for each individual patient, thereby enhancing
efficacy and safety.
