Current therapeutic strategies for inflammatory bowel disease (IBD) have reached a
plateau in the rates of response and/or remission achieved with a single therapeutic
agent. Consequently, the advanced combination therapy (ACT) strategy has emerged as
a novel treatment concept for IBD. ACT involves the use of two different targeted
therapies, whether biologic or small molecules, with the primary goal of overcoming
the therapeutic plateau. Real-world evidence is accumulating among patients undergoing
ACT, especially those dealing with concurrent IBD and extraintestinal manifestations
or grappling with medically refractory IBD. The recently conducted VEGA study, a randomized
clinical trial, has provided crucial insights by demonstrating that the short-term
combination of dual biological agents can lead to superior disease control compared
to single agents in patients diagnosed with ulcerative colitis (UC). This suggests
that ACT holds promise as a therapeutic option to enhance disease control effectively.
However, there is still limited evidence of ACT in UC patients who have proven refractory
to biologic therapy and patients with Crohn’s disease. This review aims to discuss
whether ACT represents the optimal approach for overcoming the therapeutic ceiling
in IBD.
