STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD

Gastroenterology. 2020 Dec 21;S0016-5085(20)35572-4. doi: 10.1053/j.gastro.2020.12.031.Online ahead of print

Dan Turner 1, Amanda Ricciuto 2, Ayanna Lewis 3, Ferdinando D'Amico 4, Jasbir Dhaliwal 5, Anne M Griffiths 2, Dominik Bettenworth 6, William J Sandborn 7, Bruce E Sands 8, Walter Reinisch 9, Jürgen Schölmerich 10, Willem Bemelman 11, Silvio Danese 4, Jean Yves Mary 12, David Rubin 13, Jean-Frederic Colombel 14, Laurent Peyrin-Biroulet 15, Iris Dotan 16, Maria T Abreu 3, Axel Dignass 17, International Organization for the Study of IBD


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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 IBD patients. 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 two surveys and two voting rounds. Consensus was reached if ≥75% of participants scored the recommendation as 7-10 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 (n=39 on Crohn's Disease (CD) and n=36 on ulcerative colitis (UC)) 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 (n=70). 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 CD and histological healing in UC 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 framework should be adapted to individual patients and local resources to improve outcomes.

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