Are we ready for top-down therapy for inflammatory bowel diseases: pro.

Until the 1990s, inflammatory bowel diseases (IBD) were treated with conventional drugs, such as mesalazine, corticosteroids and thiopurines, which are effective in a proportion of IBD patients. Despite the introduction of immunosuppressive drugs, a significant number of IBD patients have a disabling disease course and, on average, a poor quality of life. The discovery of anti-TNF strategies and the development of biologics targeting several other pathways, important in the pathogenesis of ulcerative colitis and Crohn's disease, introduced a pivotal discussion. Central to this discussion is the question of whether these new therapies should be introduced early or late in the course of the disease. Important factors that are relevant for this discussion are quality of life, need for corticosteroids and surgery. This article aims to explore whether we are indeed ready for a top-down approach toward biologics.