It is Time to Revise the STRIDE Guidelines Determining Therapeutic Goals for Treat-to-Target in Inflammatory Bowel Disease

Following recommendations in rheumatoid arthritis in 2010 on treat-to-target strategy,1 this approach also gained acceptance in inflammatory bowel disease [IBD]. Treat-to-target comprises predefining a treatment goal and applying tight control and therapeutic adaptations to reach it. In Selecting Therapeutic Targets in Inflammatory Bowel Disease [STRIDE] guidelines, biomarker remission was considered as an adjunctive target in both Crohn’s disease [CD] and ulcerative colitis [UC].2 The International Organization for the Study of Inflammatory Bowel Disease [IOBD] meeting that led to this consensus was held in 2014. The CALM trial demonstrated better clinical and biochemical outcomes by utilizing a tight control algorithm, including C-reactive protein and faecal calprotectin [FC], compared to symptom-driven decision-making alone in patients with moderate-to-severe CD.3 In two randomized-controlled trials in UC, the dose of 5-aminosalicylate [5-ASA] drugs was increased in patients in clinical remission with elevated FC.4,5 Osterman and colleagues showed that more patients in the intervention group had reduced FC levels to below 200 μg/g, a cut-off associated with lower clinical relapse rates.4 In a Swedish trial, more than half [56/91] of the UC patients in clinical remission had FC levels above 300 μg/g, and dose escalation of 5-ASA reduced clinical relapse in this subgroup.5