Editorial: Targeting Urgency in <scp>IBD</scp> —A Historical Divide. Authors' Reply

We thank Drs. Noviello and Atreya for their thoughtful editorial accompanying our systematic review and meta-analysis on bowel urgency (BU) in inflammatory bowel disease (IBD) [1, 2]. We are pleased that the authors highlight the key message of our work: that BU represents a highly pertinent yet historically overlooked symptom for patients with IBD [1, 2]. We entirely agree that BU has long been under-represented in clinical trials despite its significant impact on patients' quality of life and functional status. As the editorial mentions, our study demonstrates that several advanced IBD therapies can improve or resolve bowel urgency [1]. The benefit observed with IL-23p19 inhibitors (guselkumab, mirikizumab, and risankizumab) and the JAK inhibitor upadacitinib underscores that BU is clinically responsive to advanced therapies [1]. We see this as a rationale for considering BU more explicitly in developing treatment goals, particularly given the high value patients place on this symptom. However, a key aim of our review was not only to summarise existing evidence but also to illuminate the extensive gaps that persist. We share the authors' concern that many pivotal trials of widely used advanced therapies, such as anti-TNFs, anti-integrins, and IL-12/23 inhibitors, did not include urgency as an endpoint [2]. As a result, our meta-analysis could include only a minority of available studies. This limits our ability to draw comparisons across the full therapeutic landscape. We also agree that binary reporting of BU, while allowing synthesis of available data, is insufficient for capturing clinically important granularity in BU improvement. Patients often experience substantial benefits when urgency decreases in severity even if it is not fully resolved. Future research should thus adopt validated, granular measures of urgency to better capture patient experience. For these reasons, we support the editorial's call for prospective real-world studies and systematic incorporation of urgency outcomes in future RCTs. We appreciate the editors' recognition of the importance of this topic and their support in bringing attention to a symptom that patients prioritise. It is our hope that the combination of emerging RCT data, improved measurement standards, and representative real-world evidence will together help close the historical gap in the study of bowel urgency. Sincerely, Purab Patel and Parul Tandon Purab Patel: writing – original draft, writing – review and editing, conceptualization. Parul Tandon: writing – review and editing, writing – original draft, conceptualization. The authors have nothing to report. This article is linked to Patel et al. papers. To view these articles, visit https://doi.org/10.1111/apt.70446 and https://doi.org/10.1111/apt.70476. The data that support the findings of this study are available from the corresponding author upon reasonable request.