Inflammatory bowel disease (IBD) is a group of gastrointestinal disorders characterized by chronic inflammation (pain and swelling) in the intestine, when prolonged, may cause severe damage to the GI tract. Inflammatory bowel diseases (IBD) are chronic and progressive diseases with severe long-term complications. The clinical survey has proved that people with IBD have an increased risk of developing colon (colorectal) cancer. Other potential complications of IBD are anal fistula, anal stenosis or stricture, perforated bowel, and toxic megacolon (severe intestinal swelling). Drugs like immunomodulators and corticosteroids are the most commonly used for treating IBD. However, certain chronic conditions may be recommended for surgeries to remove damaged portions of the gastrointestinal tract.

A ′treat to target′ (T2T) strategy, in which the treatment aims to achieve objective outcomes, has been widely employed in the management of chronic clinical conditions such as rheumatic diseases, and this approach is emerging as a suitable measure for treating ulcerative colitis and Crohn′s disease. The T2T strategy for IBD aims to reduce the severity of the disorder and prevent end-organ dysfunction.

According to the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) indications, mucosal healing and clinical remission are the primary targets in IBDs. Histologic remission and healing, increasingly being considered a novel target, is an area of increased research focus and is a prominent marker of treatment efficacy. Histologic healing refers to the complete recovery of the colonic mucosa; without any inflammation or structural changes. This novel approach has given rise to the new concept of ′disease clearance′, which includes clinical, endoscopic, and microscopic remission.

This study aims to review current evidence on the treat-to-target strategy compared to a stricter treat-to-clear in the IBD field. In this review, the authors discuss the T2T guidance developed by the Selecting Therapeutic Targets in Inflammatory Bowel Disease committee, new evidence published on the role of various targets in CD and UC, as well as the real-world applicability of T2T.

To summarize, early therapy using a treat-to-target (T2T) approach, which implies the identification of a pre-defined target, followed by optimization of therapy, and regular monitoring until the goal is achieved, is critical in preventing adverse long-term outcomes. An optimization or switch of therapy should be considered depending on the target′s achievement, with regular monitoring. Prospective studies including long-term data are required to ensure and identify the most appropriate targets and strategies.

Keywords: Treat-to-target; histological healing; inflammatory bowel diseases.

Source –Arianna Dal Buono, Giulia Roda, Marjorie Argollo, Eirini Zacharopoulou, Laurent Peyrin-Biroulet & Silvio Danese (2020) Treat to target or ‘treat to clear’ in inflammatory bowel diseases: one step further?, Expert Review of Gastroenterology & Hepatology, 14:9, 807-817, DOI: 10.1080/17474124.2020.1804361