Real-world data on STRIDE-II treatment targets in a pediatric cohort with inflammatory bowel disease

STRIDE (selecting therapeutic targets in inflammatory bowel disease) established evidence-based targets for treat-to-target strategies in inflammatory bowel disease (IBD). STRIDE-II designates clinical remission, C-reactive protein (CRP) normalization, and fecal calprotectin (FC) reduction as short- to intermediate-term targets, and mucosal healing as a long-term target. This study evaluated STRIDE-II application and disease control in a real-world pediatric cohort.

We retrospectively analyzed newly diagnosed pediatric IBD patients (ages 3-18 years) treated according to guidelines between June 2017 and January 2023. Time-to-reach STRIDE-II targets and time-to-first flare were assessed over 52 weeks using disease activity indices, inflammatory biomarkers (CRP, FC), and endoscopy.

Seventy-four patients were included (37 Crohn's disease [CD], 37 ulcerative colitis [UC]). All CD patients received primary maintenance therapy with immunomodulators or biologics, versus 51% UC patients. Clinical remission and CRP normalization occurred within 5-10 weeks; FC normalization within 12-19 weeks. By 6 months, combined targets (clinical remission plus CRP and FC normalization) were achieved by 54% of CD patients and 43% of UC patients. Clinical relapse after remission occurred more frequently in UC than in CD (67% vs. 43%, p = 0.0334). Follow-up endoscopy at a median of 41 weeks (CD) and 52 weeks (UC) showed endoscopic healing in 7/18 (39%) CD and 13/22 (59%) UC patients.

Most pediatric IBD patients achieved clinical remission and CRP normalization within STRIDE-II timeframes, whereas FC normalization occurred later, and relapses-particularly in UC-remained common. The notable proportion of patients with suboptimal disease control underscores the need for continuous monitoring in pediatric IBD.