Kemp Karen, Samaan Mark A, Verma Ajay M, Lobo Alan J
Department of Gastroenterology, Manchester Clinical Academic Centre, Manchester Royal Infirmary, University of Manchester, Oxford Road, Manchester M13 9WL, UK.
Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
Therap Adv Gastroenterol. 2024 Nov 7;17:17562848241280885. doi: 10.1177/17562848241280885. eCollection 2024.
Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) characterised by endoscopic inflammation, progressive bowel damage and gastrointestinal lesions. Although treatment strategies for CD have traditionally focused on a stepwise pharmacological approach to achieve clinical remission or symptom resolution, these treatment goals correlate poorly with disease activity. Thus, achieving full clinical remission and full endoscopic healing alone may be insufficient, as patients may remain at risk of inflammatory complications. Individualised 'treat-to-target' (T2T) pharmacological and treatment approaches represent a promising strategy for improving endoscopic remission and symptom resolution among patients with CD. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) and STRIDE-II guidelines, launched in 2013 and later renewed, identified individualised targets for a T2T therapeutic approach for patients with IBD. These guidelines facilitate the individualisation of target treatment goals through evidence-based, long-term (health-related quality of life, absence of disability, endoscopic healing) and intermediate/short-term (abdominal pain, stool frequency, normalisation of biomarker levels) treatment targets, allowing patients and clinicians to consider the risk-to-benefit balance of goals and selected therapeutic strategies. This article aims to summarise the STRIDE-II guidelines and provide intellectual guidance for healthcare professionals to apply the STRIDE-II principles to current clinical practice in the United Kingdom (UK). Management recommendations for primary and secondary first-line non-responders are provided, along with suggestions for utilising the endoscopic outcomes scoring system in UK clinical practice.
克罗恩病（CD）是一种慢性炎症性肠病（IBD），其特征为内镜下炎症、进行性肠损伤和胃肠道病变。尽管传统上CD的治疗策略侧重于逐步采用药物治疗方法以实现临床缓解或症状缓解，但这些治疗目标与疾病活动度的相关性较差。因此，仅实现完全临床缓解和完全内镜愈合可能并不足够，因为患者可能仍有发生炎症并发症的风险。个体化的“达标治疗”（T2T）药物治疗和治疗方法是改善CD患者内镜缓解和症状缓解的一种有前景的策略。2013年发布并随后更新的《炎症性肠病治疗靶点选择（STRIDE）》和《STRIDE-II指南》确定了IBD患者T2T治疗方法的个体化靶点。这些指南通过基于证据的长期（与健康相关的生活质量、无残疾、内镜愈合）和中/短期（腹痛、排便频率、生物标志物水平正常化）治疗靶点促进了目标治疗的个体化，使患者和临床医生能够考虑目标和所选治疗策略的风险效益平衡。本文旨在总结STRIDE-II指南，并为医疗保健专业人员将STRIDE-II原则应用于英国当前临床实践提供知识指导。还提供了针对一线治疗原发和继发无反应者的管理建议，以及在英国临床实践中使用内镜结果评分系统的建议。
