{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:17:03Z","timestamp":1788171423792,"version":"build-2803163510"},"reference-count":54,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Guselkumab is a monoclonal antibody directed against the p19 subunit of interleukin-23 (IL-23), thereby preventing IL-23 binding to the IL-23 receptor. IL-23 is a key driver of immune dysregulation and chronic inflammation in inflammatory bowel disease (IBD), making selective IL-23 inhibition an established therapeutic strategy in both Crohn\u2019s disease and ulcerative colitis. Guselkumab is the most recently approved IL-23p19 inhibitor for the treatment of both major forms of IBD. It is the first IL-23p19 inhibitor to offer a fully subcutaneous induction regimen, and preliminary phase III data has suggested potential benefits for patients with perianal Crohn\u2019s disease. In registrational trials, there were significant improvements across multiple clinical and endoscopic endpoints in comparison to ustekinumab, although these trials were not powered for formal superiority testing. This narrative review summarises the biological rationale for IL-23 blockade, reviews the available clinical evidence, discusses practical considerations for its use, and considers its place in the landscape of IBD treatments.<\/jats:p>","DOI":"10.3390\/jcm15176667","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:21:19Z","timestamp":1788168079000},"page":"6667","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Guselkumab in Inflammatory Bowel Disease: Mechanism, Clinical Efficacy, Safety, and Treatment Positioning"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4237-4989","authenticated-orcid":false,"given":"Laura","family":"White","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, London Northwest University Healthcare Trust, London SW17 0QT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esha","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Limdi","sequence":"additional","affiliation":[{"name":"Manchester Academic Health Sciences Faculty of Biology, Medicine & Health, University of Manchester, Manchester BL9 7TD, UK"},{"name":"IBD Section, Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Manchester M6 8HD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahida","family":"Din","sequence":"additional","affiliation":[{"name":"Edinburgh Inflammatory Bowel Diseases Unit, NHS Lothian, Edinburgh EH4 2XU, UK"},{"name":"Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St George\u2019s University Hospital NHS Foundation Trust, London SW17 0QT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6657-2763","authenticated-orcid":false,"given":"Sailish","family":"Honap","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St George\u2019s University Hospital NHS Foundation Trust, London SW17 0QT, UK"},{"name":"Department of Immunobiology, School of Immunology and Microbial Sciences, King\u2019s College London, London SE1 9RT, UK"},{"name":"Institute of Infection and Immunology, City St George\u2019s Hospital, University of London, London SW17 0RE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2652","DOI":"10.1056\/NEJMra2002697","article-title":"Pathophysiology of Inflammatory Bowel Diseases","volume":"383","author":"Chang","year":"2020","journal-title":"N. 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