Treat-to-Target in Ulcerative Colitis: How Soon Is Now?

TL;DR

This paper discusses the challenges and potential benefits of using a treat-to-target strategy for managing ulcerative colitis, emphasizing the need for better implementation in clinical practice.

Contribution

The paper provides a perspective on current evidence and future directions for treat-to-target strategies in ulcerative colitis, highlighting gaps in clinical practice.

Findings

Current therapies fail to adequately control ulcerative colitis for nearly half of patients according to STRIDE II criteria.

Steroid overuse and persistent inflammation are common issues in ulcerative colitis management.

A treat-to-target approach is proposed to achieve better long-term outcomes through tight monitoring and treatment escalation.

Abstract

Ulcerative colitis (UC) is a chronic progressive inflammatory bowel disease, with evolutive potential for extension to the entire colon, development of complications and need for colectomy. Therapeutic goals in UC have moved from symptom control to more stringent outcomes such as endoscopic and histologic remission, which have been observed to correlate with improved long-term outcomes. Disease clearance, a composite endpoint simultaneously including clinical remission, endoscopic and histologic healing, has been recently proposed as the ultimate target. A treat-to-target approach, as endorsed by the STRIDE II consensus, with a tight monitoring and treatment escalation when predefined endpoints are not reached, is proposed as a strategy to achieve complete disease control. However, unlike Crohn’s disease (CD), the evidence supporting this approach for the management of UC is limited and its implementation in routine clinical practice is not widely diffused. Recent real-life data show that almost half of UC patients are not adequately controlled with current therapies according to STRIDE II criteria, due to steroid overuse, persistent signs of inflammation, active extra-intestinal manifestations and impaired quality of life. This perspective paper explores current evidence and future directions on treat-to-target strategies in UC for clinical research and practice.

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