Area Editoriale
What Is New in STRIDE-II?
- The STRIDE group, under the auspices of the IOIBD, has updated the 2015 first reported STRIDE recommendations and has developed 13 updated and new recommendations for treating to target in CD and UC (STRIDE-II recommendations).
- Time to expected response, remission, and endoscopic healing with the different treatments have been introduced for incorporating the treatment targets.
- STRIDE-II added clinical response and remission as well as normalization of CRP as immediate and short-term targets.
- Reduction of FC to an acceptable range has been added as a formal intermediate treatment target.
- Pediatric targets, reflected by different measuring scales and the addition of restoration of normal growth as a formal treatment target have been added.
- Restoration of QoL and absence of disability have been added to EH as long-term targets.
- Transmural healing in CD and histological healing in UC have been newly recognized as important adjunctive measures but were not endorsed as formal new treatment targets.
Conclusion
STRIDE-II confirms that the most important long-term achievable treatment targets for patients with IBD are
clinical remission, EH, restoration of QoL, and absence of disability. Symptomatic relief has been determined as an immediate goal, acknowledging that this is rated highest by patients in studies. With the accumulating clinical evidence, serum and fecal biomarkers are endorsed as intermediate medium-term feasible treatment goals, meaning that at times treatment could be revisited solely based on these tests, to facilitate care in the clinic setting. Although the ultimate target may be complete deep healing (ie, clinical remission þ complete endoscopic and histological healing þ transmural healing), more research is needed to determine the incremental gain derived from this goal, and whether this gain is worth the therapy-related risks and the costs. Moreover, this ultimate expanded target is not achievable in most patients using currently available treatments. Nonetheless, transmural healing in CD and histological healing in UC are becoming important in adjuvant assessment of the depth of treatment response. For instance, bedside bowel ultrasound performed as point of care is gradually changing the landscape of repeated assessment of treatment response, given its noninvasive character and high feasibility.
It should be emphasized that the algorithm is a general scheme and the scientific evidence on which it is based has major gaps. Clinical decisions involve a complex analysis of the patient’s condition and available courses of action and thus clinical considerations may require decisions that vary from the suggested algorithm. For instance, elevated serum or fecal biomarkers at times may suffice to revise treatment and at other times require endoscopic confirmation to document the extent and severity of the disease before
major treatment changes. Nonetheless, STRIDE-II has attempted to collate the accumulating data on available treatment targets in an intuitive and clinically useful algorithm to facilitate long-term outcome of IBD.