Updated Management of Inflammatory Bowel Disease: Biologic Therapy and Janus Kinase Inhibitors

Abstract

Inflammatory bowel disease (IBD), comprising ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic, relapsing gastrointestinal inflammatory disorder with a growing global burden. Advances in understanding IBD pathogenesis have led to the development of targeted therapies, including biologic agents and small-molecule drugs such as Janus kinase (JAK) inhibitors, expanding therapeutic options for patients with moderate-to-severe disease. To provide an updated overview of the therapeutic roles, efficacy, and safety of biologic agents and JAK inhibitors in the management of UC and CD. A narrative literature review was conducted using relevant literature addressing the clinical application, efficacy, and safety of biologic agents and JAK inhibitors in IBD. Evidence was reviewed and synthesised narratively to describe current treatment strategies, therapeutic benefits, limitations, and safety considerations. Anti-tumour necrosis factor (TNF), anti-interleukin (IL)-12/23 or IL-23, and anti-integrin agents remain established therapies for moderate-to-severe IBD, with efficacy varying according to disease phenotype and previous treatment exposure. JAK inhibitors, particularly tofacitinib and upadacitinib, provide effective oral treatment options with rapid onset of action and no immunogenicity, while filgotinib offers an additional selective JAK1-targeted approach in selected settings. However, treatment selection requires careful consideration of infections, venous thromboembolism, major adverse cardiovascular events, malignancy, and other patient-specific risk factors. Biologic agents and JAK inhibitors have substantially expanded the therapeutic landscape of IBD. An individualised treatment strategy incorporating disease characteristics, previous treatment exposure, efficacy, safety, cost, and patient preferences is essential to optimise long-term disease control and clinical outcomes.