Patient-specific approach to combination versus monotherapy with the use of antitumor necrosis factor α agents for inflammatory bowel disease.

It is likely that the debate surrounding combination versus monotherapy will continue for the foreseeable future, because there will always be a risk-benefit ratio that must be taken into account with IBD therapy. However, because more studies now include a thoughtful approach with respect to concomitant IS therapy with inclusion of objective end points such as mucosal healing and drug pharmacokinetics, it is anticipated that this issue will become clearer over time, which will benefit patients and practitioners. The BRIDGe approach described in this review is a useful tool but must be taken in the context of the subjectivity of much of the analyzed data and the individual perspectives that influenced the results. It cannot in any way be interpreted as a clinical practice guideline or standard of care, but rather a tool that seeks to interpret and incorporate the available literature and, it is hoped, aid clinicians in making sense of the conflicting data in this area. The decision regarding the risks and benefits of combination therapy must be carefully weighed in each individual patient.