Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): Determining Therapeutic Goals for Treat-to-Target

Abstract

Evidence- and consensus-based recommendations for selecting the goals for treat-to-target strategies in patients with IBD are made available. Prospective studies are needed to determine how these targets will change disease course and patients' quality of life.

Treatment Targets in Inflammatory Bowel Disease: Current Status in Daily Practice

“…UCEIS is rather complex and time consuming, which makes it less attractive for routine use in daily practice [48]. Currently, the IOIBD consensus group recommends the endoscopic Mayo score in UC because of its ease of use and established predictive value [45,[49][50]. In line with this recommendation we found that more than half of the participants use the Mayo score (0 or ≤ 1) to define MH in UC.…”

“…This is in line with international guidelines that do not advise histological remission as a treatment target [25][26][27]. Also, IOIBD experts agreed upon histological remission as an adjunctive goal that might come into view in the future, in particular in UC [45]. A unified single definition for MH in IBD is lacking.…”

“…Of these, one-third defined MH as Mayo score 0. In the literature, the debate continues whether Mayo score 0 or 1 qualifies as a definition for MH [45,51]. Still, in UC 40% of the participants indicated the definition of MH as 'macroscopic normal mucosa' , and the same applied for 66% in CD.…”

“…Most guidelines date from around 2011 and are updated every 3 years [25][26][27]. Indeed, a recent consensus meeting initiated by the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) did define composite treatment targets for both UC and CD, combining both clinical and endoscopic remission [45]. Also, the majority of these respondents have fewer years of working experience.…”

Defining success in treating patients with inflammatory bowel disease

“…Post-hoc analyses from clinical trials showed that endoscopic remission or mucosal healing (MH) affected long-term clinical outcomes, and this observation led to a shift toward endoscopic remission being considered one of the goals of treatment. Subsequently, the STRIDE program examined different possible targets in the treatment and monitoring of IBD and proposed multiple targets of clinical and patient-reported outcomes (PROs), as well as endoscopic remission for both CD and UC [5].…”