Inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), have brought significant health challenges due to their relapsing nature and impact on quality of life [1,2]. These chronic disabling conditions represent a burden for patients from the very first years following diagnosis [[3], [4], [5]]. In this regard, IBD management has evolved in the last years, with a better understanding of disease impact on the patient [6]. For several years, conventional therapies such as thiopurines, methotrexate, aminosalicylates and corticosteroids were the cornerstone of IBD therapeutic management [7,8]. In the late 1990s, the introduction of anti-TNF-alpha agents revolutionized the treatment landscape for these conditions and paving the way for other advanced therapies [9]. Since then, an expanding array of treatments has emerged, offering new hope for more personalized and effective therapeutic approaches [10].

For more than ten years, anti-TNF alpha agents were the only advanced therapy available in the management of IBD patients and therefore led to the overtreatment of many patients due to the lack of other therapeutic options. In recent years, the expansion of novel drug options has led to defining relevant treatment targets to improve IBD outcomes. Management of IBD focused for a long time on symptomatic control with little effect on the progressive disease course [11]. Indeed, studies showed that up to 50 % of patients in clinical remission presented objective biochemical or endoscopic activity of the disease [11,12]. Hence, therapeutic management of IBD shifted to incorporate biochemical and endoscopic disease control to prevent bowel damage and disability [13,14].

Recognizing the need to minimize disease activity in the early stages of the disease has led to the adoption of a “treat-to-target” strategy in disease management, endorsed by the Selecting Therapeutic Targets in Inflammatory Bowel Disease initiative (STRIDE) and STRIDE-II guidelines [15,16]. This approach involves regular follow-up and systematic monitoring of treatment response within a specified timeframe, guided by a predefined treatment target. If the target is not achieved, treatment escalation is initiated, which may include dose intensification of the current therapy, the addition of a supplementary therapy, or switching to an alternative treatment option. Nevertheless, in clinical practice, this strategy needs to be part of a shared decision-making model between the clinician and the patient [17].

The emergence of tighter therapeutic targets led to higher rates of treatment failure and with it the need for additional advanced therapies [18,19]. Currently, ten advanced therapies are authorized for the treatment of IBD in Europe, but their use is influenced by their reimbursement in each country. Furthermore, various considerations are influencing the therapeutic sequencing, such as patient comorbidities, preferred course of administration, disease location or severity, and prior advanced therapies exposure [20]. Therapeutic sequencing based on patient-specific risk stratification is an emerging concept that will help shape the future of personalized medicine. The aim of this narrative review is to reflect on which sequence allows us to reach treatment target for our patients and how this sequence can be optimized according to each patient starting from their first line of advanced therapy.