Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) characterised by endoscopic inflammation, progressive bowel damage and gastrointestinal lesions. Although treatment strategies for CD have traditionally focused on a stepwise pharmacological approach to achieve clinical remission or symptom resolution, these treatment goals correlate poorly with disease activity. Thus, achieving full clinical remission and full endoscopic healing alone may be insufficient, as patients may remain at risk of inflammatory complications. Individualised 'treat-to-target' (T2T) pharmacological and treatment approaches represent a promising strategy for improving endoscopic remission and symptom resolution among patients with CD. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) and STRIDE-II guidelines, launched in 2013 and later renewed, identified individualised targets for a T2T therapeutic approach for patients with IBD. These guidelines facilitate the individualisation of target treatment goals through evidence-based, long-term (health-related quality of life, absence of disability, endoscopic healing) and intermediate/short-term (abdominal pain, stool frequency, normalisation of biomarker levels) treatment targets, allowing patients and clinicians to consider the risk-to-benefit balance of goals and selected therapeutic strategies. This article aims to summarise the STRIDE-II guidelines and provide intellectual guidance for healthcare professionals to apply the STRIDE-II principles to current clinical practice in the United Kingdom (UK). Management recommendations for primary and secondary first-line non-responders are provided, along with suggestions for utilising the endoscopic outcomes scoring system in UK clinical practice.
Keywords: Crohn’s disease; STRIDE-II; UK clinical practice; best practice; guidelines; inflammatory bowel disease.
Best practice suggestions for incorporating STRIDE-II into UK clinical practice for the management of patients with Crohn’s disease Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) characterised by endoscopic inflammation and damage, estimated to affect approximately 11 individuals per 100,000 annually in the United Kingdom (UK). Traditional treatment strategies for IBD, including CD, focus on symptom resolution and clinical remission. However, as symptom resolution correlates poorly with disease activity, a treatment goal of full clinical remission and full endoscopic healing alone may be insufficient. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) and STRIDE-II initiative released ‘treat-to-target’ therapy evidence-based guidelines, detailing individualised clinical treatment targets for patients with IBD. STRIDE-II accommodates treatment individualisation through several long-term (health-related quality of life, absence of disability, endoscopic healing) and intermediate/short-term (abdominal pain, stool frequency, normalisation of biomarker levels) treatment targets, allowing patients and clinicians to consider the risk-to-benefit balance of goals and selected therapeutic strategies. This article provides best practice suggestions for healthcare professionals to apply the STRIDE-II principles to current clinical practice in the UK. Management recommendations for primary and secondary first-line non-responders are provided, along with suggestions for utilising the endoscopic outcomes scoring system in UK clinical practice.
© The Author(s), 2024.