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

AbstractThe traditional management of inflammatory bowel disease, based on treatment intensification guided by clinical activity alone, has been revised in the last 10  years and a treat-to-target approach has been proposed and is currently under evaluation as a disease-modifying strategy. Treat-to-target focuses on objective and scheduled measures to monitor intestinal damage, with consequent therapeutic adjustments in case of failure to achieve pre-defined targ ets. Identification of targets has been set out by the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) committee in 2015. Mucosal healing is universally accepted as the main target both in Crohn’s disease and ulcerative colitis, given its proven association with better long-te rm outcomes than clinical remission alone. Equally important is to ensure patients’ clinical remission and improve patient-reported outcomes. Transmural healing (for Crohn’s disease) and histological remission (for ulcerative colitis), listed as adjunctive targets, are likely to become primary t argets in the near future. The ultimate goal of this approach is to modify the natural history of inflammatory bowel diseases by trying to block bowel damage progression, with interventions in the pre-clinical stage. In this review, we will discuss the current recommended therapeutic targets, as wel l as those that are considered adjunctive targets, with a focus on the limited pediatric literature available. Prospective long-...
Source: Pediatric Drugs - Category: Pediatrics Source Type: research