Dan Turner1, Amanda Ricciuto2, Ayanna Lewis3, Ferdinando D'Amico4, Jasbir Dhaliwal5, Anne M Griffiths2, Dominik Bettenworth6, William J Sandborn7, Bruce E Sands8, Walter Reinisch9, Jürgen Schölmerich10, Willem Bemelman11, Silvio Danese4, Jean Yves Mary12, David Rubin13, Jean-Frederic Colombel8, Laurent Peyrin-Biroulet14, Iris Dotan15, Maria T Abreu3, Axel Dignass16. 1. Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Jerusalem, Israel. Electronic address: turnerd@szmc.org.il. 2. Hospital for Sick Children, Toronto, Canada. 3. Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. 4. Humanitas Clinical and Research Center - IRCCS, Rozzano and Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy. 5. Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio. 6. Department of Medicine B for Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany. 7. Division of Gastroenterology, University of California San Diego, La Jolla, California. 8. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York. 9. Medical University of Vienna, Department of Internal Medicine III, Division Gastroenterology and Hepatology, Vienna, Austria. 10. (Private Practice), Hofheim, Germany. 11. Department of Surgery, Amsterdam UMC, University of Amsterdam, Locatie AMC, the Netherlands. 12. Inserm UMR1153 CRESS, équipe ECSTRRA, Université de Paris, Paris, France. 13. Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois. 14. Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France. 15. Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 16. Department of Medicine I, Agaplesion Markus Hospital, Goethe University, Frankfurt/Main, Germany. Electronic address: axel.dignass@fdk.info.
Abstract
BACKGROUND: The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) has proposed treatment targets in 2015 for adult patients with inflammatory bowel disease (IBD). We aimed to update the original STRIDE statements for incorporating treatment targets in both adult and pediatric IBD. METHODS: Based on a systematic review of the literature and iterative surveys of 89 IOIBD members, recommendations were drafted and modified in 2 surveys and 2 voting rounds. Consensus was reached if ≥75% of participants scored the recommendation as 7 to 10 on a 10-point rating scale. RESULTS: In the systematic review, 11,278 manuscripts were screened, of which 435 were included. The first IOIBD survey identified the following targets as most important: clinical response and remission, endoscopic healing, and normalization of C-reactive protein/erythrocyte sedimentation rate and calprotectin. Fifteen recommendations were identified, of which 13 were endorsed. STRIDE-II confirmed STRIDE-I long-term targets of clinical remission and endoscopic healing and added absence of disability, restoration of quality of life, and normal growth in children. Symptomatic relief and normalization of serum and fecal markers have been determined as short-term targets. Transmural healing in Crohn's disease and histological healing in ulcerative colitis are not formal targets but should be assessed as measures of the remission depth. CONCLUSIONS: STRIDE-II encompasses evidence- and consensus-based recommendations for treat-to-target strategies in adults and children with IBD. This frameworkshould be adapted to individual patients and local resources to improve outcomes.
BACKGROUND: The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) has proposed treatment targets in 2015 for adult patients with inflammatory bowel disease (IBD). We aimed to update the original STRIDE statements for incorporating treatment targets in both adult and pediatric IBD. METHODS: Based on a systematic review of the literature and iterative surveys of 89 IOIBD members, recommendations were drafted and modified in 2 surveys and 2 voting rounds. Consensus was reached if ≥75% of participants scored the recommendation as 7 to 10 on a 10-point rating scale. RESULTS: In the systematic review, 11,278 manuscripts were screened, of which 435 were included. The first IOIBD survey identified the following targets as most important: clinical response and remission, endoscopic healing, and normalization of C-reactive protein/erythrocyte sedimentation rate and calprotectin. Fifteen recommendations were identified, of which 13 were endorsed. STRIDE-II confirmed STRIDE-I long-term targets of clinical remission and endoscopic healing and added absence of disability, restoration of quality of life, and normal growth in children. Symptomatic relief and normalization of serum and fecal markers have been determined as short-term targets. Transmural healing in Crohn's disease and histological healing in ulcerative colitis are not formal targets but should be assessed as measures of the remission depth. CONCLUSIONS: STRIDE-II encompasses evidence- and consensus-based recommendations for treat-to-target strategies in adults and children with IBD. This frameworkshould be adapted to individual patients and local resources to improve outcomes.