Treat to target in Crohn’s disease:A practical guide for clinicians  

作　　者：Ashish R Srinivasan 

机构地区：[1]Department of Gastroenterology,Austin Health,Victoria,Melbourne 3083,Australia [2]Department of Gastroenterology,Eastern Health,Victoria,Melbourne 3128,Australia [3]Department of Medicine,University of Melbourne,Victoria,Melbourne 3052,Australia

出　　处：《World Journal of Gastroenterology》2024年第1期50-69,共20页世界胃肠病学杂志（英文版）

摘　　要：A treat-to-target(T2T)approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease.The Selecting Therapeutic Targets in Inflammatory Bowel Disease(STRIDE)-II guidelines specify short,intermediate,and long-term treatment goals,documenting specific treatment targets to be achieved at each of these timepoints.Scheduled appraisal of Crohn’s disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified.Consensus treatment targets in Crohn’s disease comprise combination clinical and patient-reported outcome remission,in conjunction with biomarker normalisation and endoscopic healing.Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing,clinicians must consider that this may not always be appropriate,acceptable,or achievable in all patients.This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets.The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques,particularly intestinal ultrasound,holds great promise;as do emerging treatment targets such as transmural healing.Two randomised clinical trials,namely,CALM and STARDUST,have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn’s disease.Findings from these studies reflect that patient subgroups and Crohn’s disease characteristics likely to benefit most from a T2T approach,remain to be clarified.Moreover,outside of clinical trials,data pertaining to the real-world effectiveness of a T2T approach remains scare,highlighting the need for pragmatic real-world studies.Despite the obvious promise of a T2T approach,a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake.This highlights the need to describe strategies,processes,and models of care ca

关 键 词：Treat to target Inflammatory bowel disease Crohn’s disease Treatment targets Endoscopic remission Transmural healing Time to response Intestinal ultrasound 

分 类 号：R574.62[医药卫生—消化系统]