Understanding Patient Preferences on Inflammatory Bowel Disease Treatment Modalities and Outcomes: A Global Targeted Literature Review.

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Learn more: PMC Disclaimer | PMC Copyright Notice Adv Ther . 2026 Mar 31;43(6):2371–2386. doi: 10.1007/s12325-026-03565-9 Understanding Patient Preferences on Inflammatory Bowel Disease Treatment Modalities and Outcomes: A Global Targeted Literature Review Isabelle Whittle 3 , Eva Brown Hajdukova 2 , Hannah Coles 3 , Natasha Perry 3 , Lisa Perrett 3 , Richard Perry 3, ✉ , Kyran Jones 1 Author information Article notes Copyright and License information 1 Sanofi, 450 Water Street, Cambridge, MA 02141 USA 2 Sanofi, 82 Av. Raspail, 94250 Gentilly, France 3 Adelphi Values PROVE, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield SK10 5JB UK ✉ Corresponding author. Received 2026 Jan 14; Accepted 2026 Mar 6; Issue date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ . PMC Copyright notice PMCID: PMC13222193  PMID: 41915116 Abstract Introduction Inflammatory bowel diseases (IBDs) are chronic diseases, including Crohn’s disease (CD) and ulcerative colitis (UC). Given the heterogeneity in disease presentation, treatment responses, and lifestyle impacts associated with IBD, understanding patient preferences is essential to inform patient-centered care. By identifying how patients prioritize different aspects of treatment, physicians can provide more personalized, effective management of IBD. Methods A global targeted literature review search was conducted in MEDLINE and Embase between January 1, 2004 and July 30, 2024, supplemented by conference abstracts to explore patient preferences on treatment modalities and treatment outcomes in IBD. Results Sixty-two studies were identified that matched inclusion criteria. Across studies, it was identified that patients primarily base their treatment decisions on a hierarchy of three factors: efficacy, safety, and ease of administration. Treatment efficacy was often attributed higher importance than safety/tolerability, with factors “time to response” and “improvement in quality of life (QoL)” ranked highly for consideration by patients. Variations in symptom priorities were noted between patients with UC and CD, with patients with UC prioritizing diarrhea reduction while those with CD focusing on abdominal pain relief. Treatment preferences were influenced by route of administration and the ability to self-administer treatments, illustrating the diversity of patient preferences in IBD. Preference for subcutaneous (SC) over intravenous (IV) administration was noted; however, this preference was often dependent on other factors including dosing frequency, ease of use, and previous treatment experiences. Conclusion Patient treatment preferences in IBD represent a trade-off between many factors. However, preferences are highly individualized based on patient experience; as such, there is a need to promote shared decision-making between patients and physicians. To support this, patients should be equipped with the necessary resources to facilitate informed decision-making and active involvement in discussions with their healthcare providers, ensuring that treatment plans align with their personal values and preferences. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-026-03565-9. Keywords: Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Patient preference, Route of administration Key Summary Points A targeted systematic literature search of MEDLINE and Embase databases (January 2004–July 2024) was performed to identify evidence on how patients with inflammatory bowel disease (IBD) approach treatment selection and value clinical outcomes, with supplementary inclusion of conference abstracts to capture emerging insights. Among the 62 studies analyzed, patient decision-making was predominantly driven by three interconnected considerations: achieving clinical efficacy, minimizing safety risks, and selecting convenient treatment modalities. Disease-specific differences emerged in treatment priorities, with patients managing ulcerative colitis (UC) emphasizing control of diarrhea, whereas those with Crohn’s disease (CD) prioritized abdominal pain management. Practical treatment characteristics, including injection versus oral formulations and self-administration capability, shaped patient preferences; however, these considerations were modulated by clinical factors such as dosing frequency, operational simplicity, and prior therapy experiences. The findings underscore the heterogeneity of patient preferences across the population with IBD, highlighting the critical importance of implementing structured shared decision-making approaches to align treatment selection with individual patient values and priorities. Open in a new tab Introduction Inflammatory bowel diseases (IBDs) are a group of life-long, debilitating diseases primarily including Crohn’s disease (CD) and ulcerative colitis (UC) [ 1 ]. These diseases are characterized by persistent chronic inflammation of the gastrointestinal (GI) tract, with CD affecting any part of the GI tract, from the mouth to the anus, and UC being confined to the colon and rectum [ 1 ]. IBDs are associated with a range of burdensome symptoms that can flare unpredictably and fluctuate in intensity and duration, including abdominal pain, chronic diarrhea, rectal bleeding, weight loss, and fatigue. Symptoms contribute to a significantly lower patient quality of life (QoL) physically, emotionally, and socially as well as increased healthcare resource utilization [ 2 – 6 ]. Both CD and UC vary in severity from mild/moderate to severe, with treatment escalation recommended based on disease severity [ 7 , 8 ]. Disease progression is often characterized by periods of remission and relapse, and as such, treatment strategies must be individualized based on the severity and course of the disease. Current treatments focus on suppressing GI inflammation with a goal of remission; however, in cases where the disease becomes refractory to medical therapy, surgical intervention, such as bowel resection or colectomy, may be necessary to manage complications and restore quality of life [ 6 – 8 ]. Current treatment options include conventional immunosuppressant therapies such as aminosalicylates, corticosteroids, thiopurines, methotrexate, or biologics such as anti-tumor necrosis factor agents (e.g., adalimumab, certolizumab pegol, infliximab), anti-integrin (e.g., vedolizumab), and anti-IL monoclonal antibodies (e.g., ustekinumab) [ 9 , 10 ]. Corticosteroids are commonly used to treat IBD flare-ups; however, both high doses or long-term use are associated with an increased risk of infection [ 11 ]. Concomitant medications may be required in treatment resistant IBD, or to treat extraintestinal symptoms, though it may be associated with an increased risk of adverse events (AEs) and malignancies [ 12 ]. These treatments do not relieve symptoms for all patients as a result of contraindication, or primary or secondary non-response, with the only alternative being surgery [ 10 , 13 ]. Surgery to treat IBD involves removal of diseased sections of the bowel, which can offer relief from severe symptoms; however, the disease can recur in other areas of the bowel [ 14 ]. This recurrence can occur in the remaining bowel or in areas adjacent to the resected portion, requiring ongoing medical management and possibly additional surgical interventions. Further, colectomy in IBD is associated with complications, the most common long-term complications include pouchitis (29%), fecal incontinence (21%), and small bowel obstruction (17%) [ 15 ]. Patient concern regarding treatment encompasses the uncertainty around the possible need for surgery, the effectiveness and requirement for concomitant medication, and the long-term effects of treatment, highlighting a need to further understand patient preferences for treatment and treatment outcomes [ 6 ]. Understanding patient preferences is fundamental to shared decision-making (SDM), a process in which healthcare delivery is collaboratively tailored by both clinician and patient, thereby enhancing clinical outcomes and patient satisfaction [ 16 ]. Incorporating patient preferences into health technology assessments (HTAs) has been proposed to enhance the uptake of interventions, improve adherence, and increase patient satisfaction [ 17 ]. As a result of the chronic and fluctuating nature of IBD, understanding patient preferences is particularly valuable in supporting more effective and individualized management strategies. This structured literature review aimed to narratively explore existing literature on patients’ preferences for treatment and treatment outcomes: To identify and understand patient preferences concerning treatment modalities for IBD with a focus on factors such as treatment frequency, route of administration (RoA), prioritization of efficacy and safety, avoidance of steroids, minimization of long-term complications, and other relevant considerations To evaluate treatment outcomes desired by patients with IBD, including key symptoms to address, risk of serious adverse events, and expectations regarding time to symptom resolution Methods This review synthesizes previously published studies and did not involve human participants, identifiable personal data, or animal research; therefore, ethics committee approval and informed consent were not required. Literature Search A comprehensive targeted literature review was conducted to identify relevant studies reporting on patient preferences in adults with a diagnosis of UC or CD. Embase and MEDLINE databases were searched using the Ovid® platform to identify relevant studies published from 2004 to July 2024 (for the search strategy see Supplementary Material Table 1 ). In addition, key IBD-related congresses not already indexed in Embase were manually searched for congresses of interest. These were the American College of Gastroenterology (ACG), Advances in IBD (AIBD), and United European Gastroenterology (UEG) Week. Identified studies were screened against predetermined eligibility criteria. The inclusion criteria were as follows: (1) Population: adult participants aged ≥ 18 years with a confirmed diagnosis of UC or CD, regardless of treatment regimen; (2) Study Design: observational studies and patient preference studies, including qualitative research; (3) Publication Period: peer-reviewed publications indexed between 2004 and 2024, and conference abstracts from 2022 to 2024; and (4) Outcomes: studies reporting patient perspectives, preferences, and expectations regarding treatment and treatment outcomes, including the following: Current or desired treatment frequency, route of administration (e.g., injection vs oral), comedication, treatment escalation Key symptoms to address, balance of efficacy and safety, including minimization of long-term complications, long-term maintenance of remission, and avoidance/delay of surgery Serious adverse events to avoid Time to symptom resolution (See full criteria in Supplementary Material Table 2 ). Study Selection Title and abstract screening for 30% of retrieved records was completed by a single reviewer and checked by a senior reviewer (IW and RP). These records were used to train a machine-learning classifier within the DistillerSR literature review software, which reviewed the remaining 70% of records at title and abstract level. Manual quality checks of 10% of records assigned by machine learning were conducted by IW and RP, including a random sample and all records within 0.1 score of the inclusion/exclusion decision threshold (i.e., classifier assigns a score of 0 [exclusion] to 1 [inclusion], therefore all scores 0.4–0.6 were manually checked). Full texts were 100% screened by a single human reviewer according to the same screening criteria, with 30% quality checked by a senior reviewer. The final list of included records was taken forward to data extraction. All data were extracted by one reviewer and checked by a senior reviewer. To mitigate the risk of missing relevant studies, citation checks were conducted on identified systematic literature reviews which met the inclusion criteria. Titles and abstracts retrieved from the gray literature searches of conference proceedings dating from 2022 to 2024 were also screened against the same eligibility criteria (Supplementary Material Table 2 ). Results A total of 62 studies were included in the targeted literature review (TLR) (Fig. 1 ), of which 61 were sourced from the primary OVID search and one study was captured in the gray literature search from relevant conference proceedings (Supplementary Material Table 2 ). Of the identified studies, 50 were full-text studies and 12 were conference abstracts [ 15 , 18 – 78 ]. Fig. 1. Open in a new tab PRISMA flow: database and conference searches for the targeted literature review The TLR identified a global spread of studies across Europe ( n = 37) [ 15 , 20 , 22 – 24 , 26 – 28 , 30 , 31 , 40 – 42 , 44 , 45 , 48 , 50 – 55 , 57 , 60 – 64 , 66 , 68 , 71 – 77 ], North America ( n = 11) [ 18 , 21 , 25 , 29 , 32 – 35 , 39 , 59 , 65 ], Asia–Pacific ( n = 7) [ 36 , 46 , 47 , 56 , 67 , 69 , 70 ], and South America ( n = 1) [ 78 ], with six multiregional studies also captured [ 19 , 37 , 38 , 43 , 49 , 58 ]. From the identified studies, a variety of study designs were captured, including 36 cross-sectional studies [ 15 , 18 – 20 , 23 , 25 , 26 , 29 , 35 , 38 , 39 , 42 , 44 , 46 – 54 , 56 – 58 , 62 , 64 , 65 , 67 – 69 , 71 , 74 – 76 , 78 ], 12 cohort studies [ 22 , 31 , 33 , 36 , 55 , 60 , 61 , 63 , 70 , 72 , 73 , 77 ], nine discrete choice experiments [ 21 , 27 , 28 , 30 , 32 , 40 , 41 , 45 , 59 ], four conjoint analyses [ 34 , 37 , 43 , 66 ], and one Delphi panel [ 24 ]. Across the 62 included studies, most reported on relevant outcomes in IBD populations without specifying the subtype ( n = 24) [ 20 , 22 , 26 , 31 , 37 , 42 , 43 , 51 , 52 , 54 , 55 , 57 , 60 – 62 , 64 , 69 – 71 , 73 , 75 – 78 ]. This was followed by studies focusing exclusively on UC ( n = 18) [ 15 , 19 , 21 , 23 , 24 , 28 – 30 , 35 , 36 , 41 , 45 , 47 , 49 , 56 , 66 , 68 , 72 ] and studies reported relevant outcomes stratified by IBD subtype (UC and CD) ( n = 12) [ 18 , 25 , 27 , 38 – 40 , 48 , 50 , 53 , 58 , 63 , 74 ], while only 8 studies reported on CD populations exclusively [ 32 – 34 , 44 , 46 , 59 , 65 , 67 ]. Treatment Satisfaction Studies reporting on IBD highlight a persistent unmet need for improved treatment satisfaction among patients with IBD. In total, 31 studies were identified that reported on treatment satisfaction. Of which, these studies reported on Europe ( n = 20) [ 15 , 22 , 23 , 27 , 31 , 42 , 50 – 55 , 62 , 68 , 72 – 77 ], North America ( n = 5) [ 25 , 29 , 34 , 35 , 39 ], and Asia–Pacific ( n = 2) [ 47 , 56 ], with an additional four studies were multiregional (across both Europe and North America) [ 19 , 38 , 43 , 49 ]. Of the studies that captured treatment satisfaction, the treatments assessed varied greatly. Dissatisfaction with treatment was associated with a lack of treatment control and unpleasant side effects across studies [ 15 , 42 , 50 , 72 ]. Burisch et al., 2024 noted that 37% of patients with UC and 39% of patients with CD were dissatisfied with their current treatment across a survey of 1040 patients (UC, n = 502; CD, n = 538), despite the majority of patients receiving advanced therapies [ 50 ]. Among the surveyed patients, 66% of those with UC and 70% of those with CD were in remission [ 50 ]. However, of these patients, 64% with UC and 74% with CD reported experiencing residual symptoms such as urgency, pain, and fatigue [ 50 ]. As such, many patients experience residual symptoms that impair HRQoL, including those in remission [ 50 ]. This finding was further supported by Peyrin-Biroulet et al., 2016 in a European cross-sectional study, which revealed that 25% of patients with controlled UC reported dissatisfaction with various treatments, suggesting that factors beyond treatment efficacy may influence patient satisfaction [ 15 ]. A range of factors influence patient preference, including form of IBD (CD or UC), previous medication experience, duration of treatment, and frequency. There was no clear trend in preferences across or within countries, emphasizing the highly individualized influences on preference [ 15 , 18 – 78 ]. The identified studies were heterogeneous in terms of patient population and often reported measures that were difficult to reliably compare or synthesize across studies. For example, for studies reporting relative attribute importance (RAI) ( n = 9) [ 18 , 23 , 34 , 35 , 37 , 48 , 58 , 66 , 68 ], patients were asked to rank the importance of multiple treatment attributes. However, the number and definition of attributes varied considerably between studies, and the interaction between the attributes (i.e., whether an increase in the value of one attribute over time reflects increasing priority of that attribute or decreasing value of another attribute) complicates direct comparisons across studies. This variability in study design and reporting limited the ability to draw consistent conclusions. Efficacy and Safety A total of 30 studies addressed efficacy and safety concerns or needs of patients with IBD. These publications reported on multiple regions, including Europe ( n = 15) [ 15 , 20 , 22 – 24 , 26 – 28 , 30 , 31 , 40 – 42 , 44 , 45 ], North America ( n = 9) [ 18 , 21 , 25 , 29 , 32 – 35 , 39 ], Asia–Pacific ( n = 2) [ 36 , 46 ], and an additional four studies were multiregional ( n = 4) [ 19 , 37 , 38 , 43 ]. Outcomes of interest varied across studies reporting on safety and efficacy. However, AEs/side effects and efficacy concerns were reported most frequently, with disease control and improved QoL less frequently reported (Fig. 2 ). Fig. 2. Open in a new tab Number of studies ( n = 62) reporting on safety and efficacy outcomes. AE adverse events, QoL quality of life, SAE serious adverse event. *Number exceeds total number of studies as studies reported on multiple outcomes Across studies, efficacy and safety were both consistently reported as the most important attributes that patients consider. However, treatment efficacy was ranked as the most important factor influencing patient preferences, ranking higher than safety or tolerability concerns across two studies [ 37 , 46 ]. In a conjoint analysis by Patel et al., 2021, patients with IBD ( n = 1077) in Canada, the UK, and USA considered efficacy as more important than safety, although standard deviation for mean importance scores overlapped between safety and efficacy across all cohorts [ 37 ]. In a study by Gisbert et al., 2024, patients expressed a preference for medications that offered a greater likelihood of achieving remission, even when those medications carried a higher risk of AEs [ 28 ]. In this study, patients were willing to tolerate a higher risk of blood clots, serious infections, and malignancies to increase their chances of remission by 20% [ 28 ]. Similarly, in a Chinese cross-sectional study by Yao et al., 2021, efficacy was determined to be the main driver of treatment choice in patients with CD ( n = 127), outranking safety with no differences in decision-making observed across ages and sex (Fig. 3 ) [ 46 ]. Fig. 3. Open in a new tab Multiple choice answers for reason(s) driving patient ( n = 127) choice for treatment*. *Results demonstrate reasons driving choice for treatment with ustekinumab specifically. Source: Adapted from Yao, 2021 [ 46 ] In a European-based survey conducted by D’Amico et al., patients with IBD ( n = 367) were instructed to rank a series of predetermined options/scenarios to assess the importance of treatment attributes [ 26 ]. The results indicated that in 71% of patients, efficacy and safety were ranked equally, 22% of patients prioritized efficacy, meanwhile only 7% prioritized safety. However, survey responses also revealed that prioritization shifts towards safety among specific populations at higher risk of AEs. D’Amico observed that 83% of patients would prioritize safety for pediatrics, pregnant women, elderly individuals, and patients with a history of malignancy [ 26 ]. Several of the identified studies explored importance and prioritization relating to specific aspects of treatment efficacy and safety. The management of key symptoms, such as abdominal pain and bowel urgency, prevention of new symptoms, slowing disease progression, and alleviating fatigue were often identified as critical goals in treatment [ 25 , 39 , 47 , 50 ]. Of note, these studies often provided multiple options for patients to rank; however, options were predetermined and informed by prior research, patient discussions, or retrospective patient data [ 25 , 39 , 47 , 50 ]. Schneider et al., 2023 reported that in a survey of 521 patients with IBD, the top three treatment goals for symptom control were consistent with the most prevalent symptoms [ 39 ]. These included reducing fatigue (54% of patients with CD, 43% of patients with UC), alleviating diarrhea (44% of patients with CD, 45% of patients with UC), decreasing the urgent need to use the bathroom (38% of patients with CD, 53% of patients with UC), and reducing abdominal pain (36% of patients with CD, 32% of patients with UC) [ 39 ]. These symptoms were identified as the top priorities for patients in terms of treatment outcomes. Trends in factors influencing the prioritization of treatment efficacy over time have also been explored. A cross-sectional study across 12 European countries by Louis et al. reported decreasing relative importance of abdominal pain as patients’ disease duration increased [ 48 ]. The relative importance of abdominal pain decreased from 33% in patients diagnosed 2–5 years previously to 12% in those diagnosed for > 5 years previously [ 48 ]. This suggests that patients may become more tolerant of certain symptoms, like abdominal pain, over time, and shift their focus toward other, potentially more burdensome aspects of their condition, such as fatigue or bowel urgency. However, it is important to acknowledge that this analysis was based on RAI, which may reflect the increasing relevance of other factors over time. Nevertheless, it indicates an evolving patient preference as disease duration progresses. Interestingly, while these trends were consistent across the study population, the relative importance of symptoms such as abdominal pain, bowel urgency, and fatigue was similar between patients with UC and CD. However, this alignment between forms of IBD varied across studies, as Charabaty et al., 2022 reported in a USA-based, cross-sectional study that notable changes in patient opinion on the key symptoms to address based on UC ( n = 206) or CD ( n = 296) diagnosis [ 25 ]. Patients with UC expressed a stronger preference for reducing diarrhea compared to patients with CD (UC, 48% vs CD, 39%) [ 25 ]. Meanwhile patients with CD expressed a stronger preference for the reduction of abdominal pain as a key symptom to address (CD, 45% vs UC, 32%; Fig. 6 ) [ 25 ]. These differences in symptom priorities underscore the distinct ways in which UC and CD impact patients’ daily lives and influence their treatment preferences. Fig. 6. Open in a new tab Patient preference of RoA based on previous experience. IV intravenous, SC subcutaneous. Source: Adapted from Van Deen, 2022 [ 43 ] Route of Administration Studies examining patient preferences regarding treatment route of administration (RoA) assessed the influence of factors such as frequency of administration, previous treatment experience, and the ability to self-administer (Fig. 4 ). Fig. 4. Open in a new tab Factors that patients with UC and CD consider the most important for a treatment to address. CD Crohn’s disease, UC ulcerative colitis. Source: Adapted from Charabaty, 2022 [ 25 ] As anticipated, preference for oral administration over injections was widely observed across patient demographics, with minimal deviation dependent on IBD form, geographical location, age, and sex [ 30 , 58 , 63 , 69 , 78 ]. Patients favored oral treatments because of the convenience and ease of administration (Fig. 5 ) [ 69 , 78 ]. Fig. 5. Open in a new tab Patient preference on RoA. IV intravenous, SC subcutaneous. Source: Adapted from Matsumoto, 2023 and Wu, 2020 [ 69 , 78 ] Preference for subcutaneous (SC) versus intravenous (IV) administration was often comparable or showed no clear preference [ 18 , 27 , 77 , 78 ]. However, in studies where a preference for SC administration was expressed, this preference was often linked to the ability to self-administer injections at home [ 15 , 18 , 71 ]. From a survey of 11 European countries, Peyrin-Biroulet et al., 2016 reported that 46% of patients with UC preferred SC self-injections every 4 weeks whereas only 36% favored less frequent in-hospital IV injections every 8 weeks [ 15 ]. Similarly, previous treatment experience also influences RoA preference. Patients with experience using injected treatments were more willing to continue with injected therapies, due to familiarity with the process and the associated challenges [ 43 , 63 ]. In a conjoint analysis of Canada, the UK, and the USA, Van Deen et al., 2022 ( n = 1077) reported that across all treatment experience levels, patient preference for either injected treatment regimens of SC every 2 weeks and IV every 8 weeks did not differ greatly. Furthermore, patients with any SC experience preferred SC over IV, while those with only IV experience or no injection experience preferred IV (Fig. 6 ). Thus, a key distinguishing factor between SC and IV administration was the patient’s ability to self-administer the injection at home, which was preferred over the need for in-hospital or nurse-administration of injections. This was supported by Dewitte et al., 2024, in a cross-sectional study in which 65% of patients ( n = 404) reported that coming into hospital disrupted their daily life [ 64 ]. Ultimately, the ability to self-inject at home was considered more important than the benefit of longer dosing intervals associated with IV administration. Two studies conducted across multiple European regions investigated how disease duration impacted patient preferences regarding RoA [ 27 , 48 ]. Fiorino et al., 2024 found that RAI for RoA was similar between patients with a disease duration of < 11 years and those with a duration of ≥ 11 years ( n = 686) [ 27 ]. These findings suggest that while RoA may be a more prominent factor early in the disease course, preferences can stabilize over time as patients adjust to chronic disease management and long-term treatment regimens. Conversely, Louis et al., 2023 reported that RAI of RoA was significantly higher for patients diagnosed for > 5 years previously, with 30% of these patients prioritizing RoA compared to just 16% in those diagnosed 2–5 years previously ( p = 0.001) ( n = 400) [ 48 ]. These studies may have reported varying results due to the differences in study design, with Fiorino et al., 2024 conducting a discrete choice experiment and Louis et al., 2023 conducting a cross-sectional study. Together, these studies indicate that disease duration influences the importance of RoA in the initial years following diagnosis. As patients become accustomed to their treatment regimens, priorities may shift, with other aspects of treatment, such as efficacy or long-term disease control, becoming more central to patient preferences. Discussion IBDs are chronic conditions that require ongoing management and treatment throughout a patient’s life to manage flares [ 1 ]. Given the complex nature of the disease and the diverse range of available therapies, this study aimed to explore the variability in patient preferences, and how these preferences can shift based on factors such as disease experience, treatment history, and individual circumstances. Across multiple studies, it was found that patients primarily base treatment decisions on a trade-off between efficacy, safety, and ease of administration. While each of these factors plays a role in patient preference, efficacy emerged as the most important consideration with safety a close second when selecting a treatment [ 37 , 46 ]. This marginal preference for efficacy can be attributed to the profound impact IBD symptoms have on patients’ daily lives [ 25 , 39 , 47 , 50 ]. Symptoms such as abdominal pain, diarrhea, and fatigue can be debilitating, and can outweigh concerns about treatment-related AEs [ 37 , 46 ]. Notably, symptom priorities differed slightly between UC and CD, patients with UC placing greater importance on reducing diarrhea, and patients with CD on alleviating abdominal pain [ 25 ]. This further underscores the variability in patient experiences and priorities across different types of IBD and emphasizes the need for personalized IBD management approaches that reflect the unique symptom profiles and priorities of each patient. Treatment preferences were also affected by other factors including RoA, and the ability to self-administer treatments. Each of these factors plays a significant role in how patients perceive and choose between available therapies [ 30 , 58 , 69 , 78 ]. While there was also notable preference for SC or IV administration in some patients, the extent of preference often depended on factors such as dosing frequency, ease of use, and previous treatment experiences [ 15 , 18 , 43 , 58 , 63 , 67 ]. A preference for more frequent SC injections compared to less frequent IV injections was identified when patients were able to self-administer SC injections at home, potentially highlighting that the setting in which the treatment is administered plays a vital role in patient preference [ 15 , 64 ]. Despite this, it was also identified that some patients expressed no clear preference between types of injections (SC vs IV) [ 27 ]. Notably, this highlights that some patients may be indifferent to the method of injection if other factors, such as efficacy or the relationship with their healthcare provider, are prioritized [ 27 ]. However, the lack of a “no preference” option in some studies may have biased results toward a specific RoA [ 15 , 18 , 27 , 30 , 43 , 58 , 63 , 67 , 69 , 78 ]. This suggests that treatment decision-making should not only focus on the available administration methods but also consider the broader context in which these preferences are formed. Offering a range of options, including allowing for “no preference,” may help to clarify true patient preferences and ensure a more informed, patient-centered approach to treatment selection. The need for individualized care in IBD management is crucial due to the disease’s complex and multifactorial nature and has been highlighted through the variability in patient preferences identified in this study. While personalized care is increasingly supported by clinical tools such as therapeutic drug monitoring, biomarker analysis, and genetic testing, these approaches focus on predicting clinical outcomes without incorporating patient preferences which may impact uptake and adherence to treatment [ 79 ]. Targeted therapy in combination with patient preference would enable physicians to make more informed, patient-centered decisions through a SDM process. Incorporating SDM into IBD management allows physicians to develop treatment plans that align with individual patient preferences and priorities, while also ensuring the approach is clinically effective, practical, and sustainable [ 16 ]. This review aimed to explore patient preferences concerning factors such as efficacy, safety, and RoA. While these factors were assessed as discrete variables, there is an inherent interplay between them that needs to be considered for a more holistic understanding of patient preferences. To truly capture the relative value of these factors, they must be viewed within the context of each other. A key limitation of this review was that many preference-related outcome measures, such as RAI, were not suitable for cross-study comparison. Additionally, most of the included studies were cross-sectional with heterogeneous, uncontrolled study populations, which hindered meaningful cross-study comparisons. Furthermore, several studies relied on hypothetical scenarios or predicted responses (e.g., discrete choice experiments, conjoint analysis), rather than actual patient experiences. The pooling of patients receiving various treatments within many studies limited the ability to compare preferences based on specific therapies. Lastly, this review focused on patient preferences for medical therapy in IBD and did not extract data by disease subtype (outside of UC and CD), perianal fistulizing disease, dietary preferences, or broader unmet needs, which limits the specificity and scope of our findings. Future research incorporating matched populations may be required to explore the precise influence of specific treatment attributes on patient preference, as well as studies that focus on treatment prioritization and the trade-offs associated with increasing dosing intervals for injected treatments, and patient preferences in specific IBD subgroups, including perianal fistulizing disease, dietary considerations, and broader unmet needs. Conclusion Overall, the available evidence suggests that treatment decisions in patients with IBD are commonly influenced by a global hierarchy of key factors, with efficacy most frequently prioritized followed by safety and ease of administration, although these patterns should be interpreted cautiously as a result of the heterogeneity of the included studies. Overarching statements about patient preferences are unsuitable because of the highly individualized nature of treatment choices highlighted in this review. Rather than generalizing, there is a clear need to amplify the patient voice and encourage shared decision-making between clinicians and patients. To support this, patients should be equipped with the necessary resources to facilitate informed decision-making and active involvement in discussions with their healthcare providers, ensuring that treatment plans align with their personal values and preferences. Future research on patient preferences in IBD management should consider including matched populations to better identify meaningful trends in preferences. However, clinicians must prioritize greater patient involvement in treatment decision-making and enhance patient awareness of available treatment options to promote adherence and optimize clinical outcomes. Supplementary Information Below is the link to the electronic supplementary material. Supplementary file1 (PDF 245 KB) (245.1KB, pdf) Acknowledgments Medical Writing/Editorial Assistance Isabella Whittle, Richard Perry, Lisa Perrett, Natasha Perry and Hannah Coles from Adelphi Values PROVE were funded by Sanofi to provide medical writing and editorial assistance in the development of this manuscript. Author Contributions Isabelle Whittle, Richard Perry, Lisa Perrett, Natasha Perry, Kyran Jones and Eva Brown Hajdukova were involved in study conception and design, material preparation, data collection and analysis. The first draft of the manuscript was written by Isabelle Whittle, Richard Perry, Lisa Perrett, Natasha Perry and Hannah Coles and all authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript. Funding The targeted literature review was funded by Sanofi, who also funded the journal’s Rapid Service and Open Access fees. Data Availability The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Declarations Conflict of Interest Isabelle Whittle, Richard Perry, Lisa Perrett, Natasha Perry and Hannah Coles are employees of Adelphi Values PROVE, which received funding from Sanofi to conduct this research. Kyran Jones was an employee of Sanofi at the time of writing and preparation of the manuscript, and Eva Brown Hajdukova works as a consultant for Sanofi and may hold stock options in the company. Kyron Jones is currently at Biogen. Ethical Approval This article is based on previously conducted studies and does not contain any new studies with human or animal participants. Footnotes Prior Presentation: The findings from this literature review were previously presented in a poster at the Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) Conference, September 4–6, 2025, Las Vegas, NV. 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