The risks and benefits of early immunosuppression and biological therapy

Crohn's disease and ulcerative colitis are heterogeneous conditions with highly variable courses of disease. Recent studies have focused on the time soon after diagnosis as a potential window of opportunity before which complicated disease behaviors have ensued and in which attaining adequate control of the inflammatory process might improve long-term outcomes. This review covers the use of immune suppression and biological therapy early in the course of inflammatory bowel disease. It includes the rationale for using these medications earlier, the features of early disease that may lead to improved outcomes with early intervention, the most optimal strategies for early treatment, the benefits of early intervention and the risks of this approach. In addition, we discuss the issue of which patients to choose for early intervention through risk stratification.