As our medical armamentarium for IBD continues to expand, it is essential that 
clinicians understand both optimizing and sequencing of individual and 
combination therapeutic approaches with available medications. Areas covered: 
This review summarizes dosing strategies and therapeutic drug monitoring for 
pharmacologic optimization in IBD. Aminosalicylates remain first-line therapies 
for mild-to-moderate UC but have limited evidence of efficacy in CD. Budesonide 
provides an alternative to aminosalicylates when targeted to appropriate sites 
in the distal small bowel and colon, as do conventional corticosteroids when 
applied rectally. Systemic steroids are highly efficacious but burdened by 
toxicity. Thiopurines or methotrexate can be utilized as steroid-sparing agents. 
Biologic agents targeting TNF remain important for steroid-sparing therapy in 
moderate-to-severe UC and CD. Newer biologics targeting lymphocyte trafficking 
and lymphocyte activation are also efficacious for moderate-to-severe IBD. Near 
future conventional drug options include oral agents such as tofacitinib and 
mongersen. Expert commentary: Positioning therapies according to the location, 
phenotypes, and severity, as well as the use of therapeutic and clinical 
targets, will improve outcomes and minimize toxicities and therapeutic 
futilities. Future IBD treatment should focus on personalized therapy plans 
based on genetic determinants, targeted mechanisms of action, and pharmacologic 
optimization.