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Treat-to-Target in Pediatric Inflammatory Bowel Disease: What Does the Evidence Say?

Giulia D'Arcangelo1, Marina Aloi2

  • 1Department of Women's and Children's Health, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.

Paediatric Drugs
|June 24, 2020
PubMed

Insights

The treat-to-target approach for inflammatory bowel diseases (IBD) uses objective measures to monitor intestinal damage, aiming for mucosal healing and clinical remission. This strategy seeks to modify IBD

Area of Science:

  • Gastroenterology and Hepatology
  • Immunology and Inflammation
  • Pediatric Gastroenterology

Background:

  • Traditional inflammatory bowel disease (IBD) management relied on clinical activity alone, often leading to delayed treatment intensification.
  • A paradigm shift towards a treat-to-target (T3) approach has emerged, focusing on objective measures for disease modification.
  • The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) committee established key targets in 2015.

Purpose of the Study:

  • To review current and emerging therapeutic targets for IBD management based on the treat-to-target strategy.
  • To highlight the importance of mucosal healing, clinical remission, and patient-reported outcomes.
  • To discuss adjunctive targets and the limited pediatric literature, emphasizing the need for pediatric-specific research.

Main Methods:

  • Literature review of current guidelines and research on treat-to-target approaches in IBD.
  • Analysis of established and proposed therapeutic targets, including mucosal, transmural, and histological healing.
  • Examination of the evidence supporting these targets and their impact on long-term outcomes.

Main Results:

  • Mucosal healing is a primary target in Crohn's disease and ulcerative colitis, associated with superior long-term outcomes compared to clinical remission alone.
  • Clinical remission and improved patient-reported outcomes are crucial components of the T3 strategy.
  • Transmural healing (Crohn's disease) and histological remission (ulcerative colitis) are emerging as important adjunctive targets.

Conclusions:

  • The treat-to-target approach, emphasizing objective measures like mucosal healing, represents a significant advancement in IBD management.
  • Future research should focus on validating transmural and histological healing as primary targets and developing pediatric-specific T3 strategies.
  • Long-term prospective trials are essential to refine monitoring algorithms and personalize therapeutic decisions for pediatric IBD patients.

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