Hyams JS, et al. - In this inception cohort study, researchers tested the assumption that pretreatment clinical, transcriptomic, and microbial factors predict the course of the disease among paediatric patients (aged 4–17 years) with newly diagnosed ulcerative colitis. Initially, patients received standardized mesalazine or corticosteroids with pre-established immunomodulator escalation criteria (ie, thiopurines) or anti-tumor necrosis factor-α (TNFα) therapy. In children who are newly diagnosed with ulcerative colitis, the utility of initial clinical activity and treatment response by 4 weeks to predict week 52 corticosteroid-free remission with mesalazine alone was supported in this analysis. Developing personalized clinical and biological signatures is promising to inform therapeutic decisions about ulcerative colitis.