Treatment endpoints in ulcerative colitis: Does one size fit all?

Area of Science:

• Gastroenterology
• Clinical Medicine
• Pharmacology

Background:

• The treat-to-target strategy in inflammatory bowel disease (IBD) aims for predefined endpoints, improving outcomes over subjective symptom assessment.
• Current guidelines, like STRIDE-II, recommend immediate, intermediate, and long-term endpoints for ulcerative colitis (UC), including clinical response, remission, and endoscopic healing.

Discussion:

• Selecting appropriate treatment endpoints in IBD, particularly UC, remains a challenge.
• Deeper remission levels, such as histologic normalization or gut barrier healing, may offer further benefits.
• Balancing treatment intensification benefits against potential harms is essential for individual patient management.

Key Insights:

• Uniform, tight disease control in IBD via treat-to-target strategies improves clinical outcomes.
• The STRIDE-II consensus provides a framework for UC treatment endpoints, but deeper remission goals warrant consideration.
• Shared decision-making between clinicians and patients regarding treatment goals and potential risks is vital.

Outlook:

• Future research should quantify the incremental benefits and risks of achieving deeper remission levels in UC.
• Informed patient-clinician discussions are needed to agree on individualized treatment endpoints.
• Optimizing IBD management requires a personalized approach to treatment target selection.