For an adult patient with newly diagnosed IBD with no co-morbidities who requires first step-up to biologics or other “advanced therapy,” would you routinely start with an anti-TNF (+/-antimetabolite), or--if insurance let you do anything you wanted—would you rather start with something else?

Recall that the first biologic you start will be the most effective. Because of the safety profile, I would start a selective anti-interleukin-23. The advantage of Tremfya is an all-subcutaneous Q induction, but Skyrizi would be fine as well.

It is too broad of a question, period. Need details and a shared decision with patient as options include steroids with azathioprine, TNFs with azathioprine. IL-23 or ustekinumab.