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Selection of an optimum treatment regimen for patients with ulcerative colitis depends on several factors, including the natural history of the disease. A new study indicates that prognosis for patients with newly diagnosed ulcerative colitis might not be as bad as typically thought—an important finding that should be taken into account when the risks and benefits of future treatment strategies are discussed.

In 2013, several new IBD drugs, including golimumab and vedolizumab, have been approved or completed successful programmes, showing efficacy in both Crohn's disease and ulcerative colitis. In addition, classic IBD drugs have been formulated for colonic delivery, such as budesonide MMX^®, which was recently approved for mild-to-moderate ulcerative colitis.

Therapy for Crohn's disease has traditionally been based on a step-up approach, with treatment with the powerful TNF antagonists reserved as a last resort before surgery. In this Review, the authors discuss the use of anti-TNF agents as first-line therapy to achieve disease modification and the challenges in selecting appropriate patients for this approach.

Evidence has accumulated to show that mucosal healing can alter the course of Crohn's disease. New results from the EXTEND trial clearly demonstrate that adalimumab is able to induce and maintain mucosal healing in Crohn's disease and has the potential for disease modification.

The landscape of treatment for IBD changed dramatically with the introduction of biologic agents, of which several are now in use for this condition. Here, the authors provide practical insights into the use of biologic agents in IBD, discussing issues such as comparative effectiveness, safety, immunogenicity, cost and patient preference.

Biosimilar monoclonal antibodies are now being accepted in clinical practice by IBD specialists. However, switching patients already undergoing originator biologic treatment to biosimilars has been debated due to lack of controlled studies. The NOR-SWITCH study now provides novel clinical evidence in switching from originator to biosimilar in patients with IBD.

The treatment of IBD is currently suboptimal. Continuous monitoring of patients with IBD, patient engagement and early treatment adjustments are still difficult hurdles. E-Health could be an efficient tool to improve these aspects, but the current evidence for its use in IBD is poor. An integrated cost-effective e-health system supported by a stable legal framework is eagerly needed.

Mucosal healing has emerged as an important treatment goal for patients with IBD. This Review article focuses on the definition of mucosal healing, the ability of available IBD medications to induce and maintain mucosal healing, and the influence of mucosal healing on the course of IBD. The article also discusses how best to integrate the treatment end point of mucosal healing into clinical practice for the management of patients with IBD.

Biologic agents have revolutionized the management of IBD and biosimilars (copy versions of the originator agents) are emerging as an alternative. This Review outlines the concept of biosimilars and their adoption in gastroenterology, their current use and future challenges.