STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD

Background: The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) has proposed treatment targets in 2015 for adult patients with inflammatory bowel disease (IBD). We aimed to update the original STRIDE statements for incorporating treatment targets in both adult and pediatric IBD.

Methods: Based on a systematic review of the literature and iterative surveys of 89 IOIBD members, recommendations were drafted and modified in 2 surveys and 2 voting rounds. Consensus was reached if =75% of participants scored the recommendation as 7 to 10 on a 10-point rating scale.

Results: In the systematic review, 11,278 manuscripts were screened, of which 435 were included. The first IOIBD survey identified the following targets as most important: clinical response and remission, endoscopic healing, and normalization of C-reactive protein/erythrocyte sedimentation rate and calprotectin. Fifteen recommendations were identified, of which 13 were endorsed. STRIDE-II confirmed STRIDE-I long-term targets of clinical remission and endoscopic healing and added absence of disability, restoration of quality of life, and normal growth in children. Symptomatic relief and normalization of serum and fecal markers have been determined as short-term targets. Transmural healing in Crohn's disease and histological healing in ulcerative colitis are not formal targets but should be assessed as measures of the remission depth.

Conclusions: STRIDE-II encompasses evidence- and consensus-based recommendations for treat-to-target strategies in adults and children with IBD. This frameworkshould be adapted to individual patients and local resources to improve outcomes.


The overall goal of this position statement is to update the previous STRIDE guidance on treatment outcomes by providing contemporary consensus recommendations for using the different targets over the treatment course. Specifically, we aimed to review and
discuss existing and potential endpoints on the basis of recently published new evidence data and to extend the previous recommendations also to pediatric IBD. Finally, we aimed to tabulate the reviewed endpoints in an escalating algorithm along the timeline of specific


Turner, D., A. Ricciuto, A. Lewis, F. D'Amico, J. Dhaliwal, A. M. Griffiths, D. Bettenworth, W. J. Sandborn, B. E. Sands, W. Reinisch, J. Scholmerich, W. Bemelman, S. Danese, J. Y. Mary, D. Rubin, J.-F. Colombel, L. Peyrin-Biroulet, I. Dotan, M. T. Abreu, A. Dignass and I. B. D. International Organization for the Study of


Journal: Gastroenterology
Volume: 160
Issue: 5
Pages: 1570 - 1583
Year: 2021
DOI: 10.1053/j.gastro.2020.12.031

Further Study Information

Current Stage: Completed
Funding source(s):

Health Area

Disease Category: Gastroenterology

Disease Name: Inflammatory bowel disease (IBD)

Target Population

Age Range: Unknown

Sex: Either

Nature of Intervention:

Stakeholders Involved

- Clinical experts

Study Type

- COS for practice


- Consensus meeting
- Delphi process
- Systematic review

A systematic review of the literature was performed in July 2019. In parallel, a survey was sent to all IOIBD members asking them to state the most important targets in UC and separately
in CD. Based on the preceding, consensus statements were drafted by the steering committee, and then sent to all IOIBD members for voting along with the literature review.

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