Treat to target
In order to develop consensus recommendations for treatment targets for UC and CD, the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) program established potential targets and the evidence supporting them.
ULCERATIVE COLITIS
The program agreed that the target for UC was the following:(7)
- Clinical and patient-reported remission (PRO), defined as resolution of rectal bleeding and diarrhea or altered bowel habit (assessed at least every 3 months until resolution, then every 6 to 12 months), plus
- Endoscopic remission is defined as a Mayo endoscopic subscore of 0 or 1 (assessed 3 to 6 months after starting therapy in symptomatic patients and then at least every 3 months during active disease).
STRIDE considered histologic remission to be an adjunctive target, as insufficient evidence exists to recommend histologic remission as a target in clinical practice.
CROHN’S DISEASE
The agreed target for CD was the following:(7)
- Clinical and PRO, defined as resolution of abdominal pain and diarrhea or altered bowel habit (as
- sessed at least every 3 months until resolution, then every 6 to 12 months), plus
- Endoscopic remission, defined as resolution of ulceration at ileocolonoscopy, or resolution of inflammation on cross-sectional imaging, in patients who could not be assessed adequately by ileocolonoscopy (assessed at least every 6 to 9 months during active disease).
STRIDE considered biomarker remission, that is, normalization of C-reactive protein and fecal calprotectin, to be an adjunctive target, as insufficient evidence exists to recommend treatment optimization based on biomarkers alone.
Reference