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Benefits and Challenges of Treat-to-Target in Inflammatory Bowel Disease

There is notable disparity between symptomatology and disease activity in a significant proportion of patients with inflammatory bowel disease (IBD), and escalation of treatment based on symptoms alone can fail to significantly alter the course of disease. The STRIDE-II position statement, published...

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Autores principales: West, Jack, Tan, Katrina, Devi, Jalpa, Macrae, Finlay, Christensen, Britt, Segal, Jonathan P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573216/
https://www.ncbi.nlm.nih.gov/pubmed/37834936
http://dx.doi.org/10.3390/jcm12196292
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author West, Jack
Tan, Katrina
Devi, Jalpa
Macrae, Finlay
Christensen, Britt
Segal, Jonathan P.
author_facet West, Jack
Tan, Katrina
Devi, Jalpa
Macrae, Finlay
Christensen, Britt
Segal, Jonathan P.
author_sort West, Jack
collection PubMed
description There is notable disparity between symptomatology and disease activity in a significant proportion of patients with inflammatory bowel disease (IBD), and escalation of treatment based on symptoms alone can fail to significantly alter the course of disease. The STRIDE-II position statement, published in 2021 by the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organisation for the Study of IBD (IOIBD) provides the most current recommendations for a treat-to-target (T2T) approach in IBD. Despite the benefits offered by a T2T approach in IBD, there are numerous drawbacks and current limitations to its widespread implementation in real-world clinical practice. Owing to the lack of a standardised definition of MH, outcome data are heterogeneous and limit the comparability of existing data. Further, studies investigating the likelihood of achieving MH with a T2T approach are limited and largely retrospective. Evidence of the real-world feasibility of tight monitoring is currently minimal and demonstrates sub-optimal adherence among patients. Further, the few studies on the acceptability and uptake of a T2T approach in real-world practice demonstrate the need for increased acceptability on both patients’ and clinicians’ behalf. Real-world applicability is further limited by the need for repeated endoscopic assessments of MH as well as a lack of guidance on how to incorporate the various treatment targets into therapeutic decision-making. We aim to review the benefits and challenges of the T2T approach and to discuss potential solutions to further patient care.
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spelling pubmed-105732162023-10-14 Benefits and Challenges of Treat-to-Target in Inflammatory Bowel Disease West, Jack Tan, Katrina Devi, Jalpa Macrae, Finlay Christensen, Britt Segal, Jonathan P. J Clin Med Review There is notable disparity between symptomatology and disease activity in a significant proportion of patients with inflammatory bowel disease (IBD), and escalation of treatment based on symptoms alone can fail to significantly alter the course of disease. The STRIDE-II position statement, published in 2021 by the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organisation for the Study of IBD (IOIBD) provides the most current recommendations for a treat-to-target (T2T) approach in IBD. Despite the benefits offered by a T2T approach in IBD, there are numerous drawbacks and current limitations to its widespread implementation in real-world clinical practice. Owing to the lack of a standardised definition of MH, outcome data are heterogeneous and limit the comparability of existing data. Further, studies investigating the likelihood of achieving MH with a T2T approach are limited and largely retrospective. Evidence of the real-world feasibility of tight monitoring is currently minimal and demonstrates sub-optimal adherence among patients. Further, the few studies on the acceptability and uptake of a T2T approach in real-world practice demonstrate the need for increased acceptability on both patients’ and clinicians’ behalf. Real-world applicability is further limited by the need for repeated endoscopic assessments of MH as well as a lack of guidance on how to incorporate the various treatment targets into therapeutic decision-making. We aim to review the benefits and challenges of the T2T approach and to discuss potential solutions to further patient care. MDPI 2023-09-29 /pmc/articles/PMC10573216/ /pubmed/37834936 http://dx.doi.org/10.3390/jcm12196292 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
West, Jack
Tan, Katrina
Devi, Jalpa
Macrae, Finlay
Christensen, Britt
Segal, Jonathan P.
Benefits and Challenges of Treat-to-Target in Inflammatory Bowel Disease
title Benefits and Challenges of Treat-to-Target in Inflammatory Bowel Disease
title_full Benefits and Challenges of Treat-to-Target in Inflammatory Bowel Disease
title_fullStr Benefits and Challenges of Treat-to-Target in Inflammatory Bowel Disease
title_full_unstemmed Benefits and Challenges of Treat-to-Target in Inflammatory Bowel Disease
title_short Benefits and Challenges of Treat-to-Target in Inflammatory Bowel Disease
title_sort benefits and challenges of treat-to-target in inflammatory bowel disease
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573216/
https://www.ncbi.nlm.nih.gov/pubmed/37834936
http://dx.doi.org/10.3390/jcm12196292
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