Department of Gastroenterology, Austin Health, Victoria, Melbourne 3083, Australia.
Department of Gastroenterology, Eastern Health, Victoria, Melbourne 3128, Australia.
World J Gastroenterol. 2024 Jan 7;30(1):50-69. doi: 10.3748/wjg.v30.i1.50.
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 capable of supporting the integration and execution of a T2T approach in real-world clinical practice. Hence, this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn's disease.
达标治疗（T2T）方法将早期干预和严格疾病控制的原则应用于克罗恩病，以优化长期结果。选择治疗靶点在炎症性肠病（STRIDE）-II 指南中指定了短期、中期和长期治疗目标，记录了在这些时间点要实现的具体治疗目标。在这些时间点，根据预先定义的治疗目标，定期评估克罗恩病的活动情况，仍然是决定是否应继续或修改当前治疗的核心。克罗恩病的共识治疗目标包括联合临床和患者报告的缓解，以及生物标志物正常化和内镜愈合。尽管 STRIDE-II 指南支持追求内镜愈合，但临床医生必须考虑到，在所有患者中，这并不总是合适、可接受或可实现的。这凸显了需要在一开始就让患者参与进来，努力实现个性化护理和个体化治疗目标。使用非侵入性生物标志物（如粪便钙卫蛋白）结合横断面成像技术，特别是肠道超声，具有很大的前景；新兴的治疗目标，如穿透性愈合，也具有很大的前景。两项随机临床试验，即 CALM 和 STARDUST，评估了 T2T 方法在实现克罗恩病患者内镜终点方面的疗效。这些研究的结果反映出，最有可能从 T2T 方法中获益的患者亚组和克罗恩病特征仍有待明确。此外，在临床试验之外，关于 T2T 方法在真实世界中的有效性的数据仍然很少，这突出了需要进行实用的真实世界研究。尽管 T2T 方法具有明显的优势，但缺乏支持其整合到真实世界临床实践中的指南有可能限制其采用。这突出了需要描述能够支持 T2T 方法在真实世界临床实践中的整合和执行的策略、流程和护理模式。因此，本综述旨在检查当前和新兴的文献，为临床医生提供关于如何将 T2T 原则纳入克罗恩病管理常规临床实践的实用指导。
