Patients and clinicians generally report suboptimal disease control at lower rates than those determined by Selecting Therapeutic Targets in IBD-II metrics.
“Crohn’s disease [CD] and ulcerative colitis [UC] are chronic and incurable, with gastrointestinal and other effects that may lead to irreversible tissue damage, diminished QOL, and permanent disability if untreated,” Jesse Siffledeen MD, MSc, FRCPC, notes. “Medical therapies, including immunomodulators, corticosteroids, and others, generally target underlying inflammation to reduce symptoms, prevent complications, and improve QOL. Frequent monitoring is important, but CD and UC symptoms may not correlate with the presence or severity of inflammation, so we need objective, regular testing for inflammation.”
Further, many patients with IBD have suboptimal disease management, “and there is a significant disconnect among clinicians and patients who overestimate how well controlled the IBD is compared with objective measures that use Selecting Therapeutic Targets in Inflammatory Bowel Disease-II (STRIDE-II) guidance,” Dr. Siffledeen continues.
For a study published in Digestive Diseases and Sciences, the researchers examined the proportions of patients with STRIDE-II-based “red flag” indications of suboptimal disease control and mean Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores. Secondary outcomes included the number of patients and clinicians who subjectively reported suboptimal control.
Real-World Application of STRIDE-II Targets
The researchers enrolled 87 adults diagnosed with CD and 76 with UC for at least 1 year. At diagnosis, patients in both groups were, on average, in their early- to mid-thirties and had had the condition for a median of approximately 10 years. All participants and clinicians completed questionnaires, entered their data electronically, and participated in one clinic visit involving assessments.
Participants who did not meet prespecified STRIDE-II–based treatment targets within a given time after starting medical therapy were classified as having suboptimal disease control. “Red flags” within around 14 days of the clinic visit included failure to achieve clinical remission, failure to achieve C-reactive protein normalization, and failure to achieve sufficient fecal calprotectin decrease. Long-term red flags within around 8 weeks of the visit included lack of endoscopic remission, magnetic resonance enterography and ultrasound findings of active disease, treatment-associated complications such as anemia, extraintestinal manifestations, perianal disease, and impaired QOL.
“Our study aimed to help define short-term goals (clinical symptoms response) and long-term goals (endoscopic healing, normalized quality of life, absence of disability), according to STRIDE-II guidelines,” Dr. Siffledeen says.
Patients & Clinicians Under-Identified Poor Control
At the clinic visit, 45 (51.7%) of the 87 patients with CD and 33 (43.4%) of the 76 patients with UC had suboptimal disease control based on STRIDE-II criteria.
Long-term red flags identified most participants with suboptimal disease control: 42 (93.3%) of 45 with CD and 30 (90.9%) of 33 with UC. Impaired QoL, identified by a score below 50 on the SIBDQ, was the red flag most likely to identify suboptimal disease control in 33 (73.3%) of 45 patients with CD and 26 (78.8%) of 33 with UC.
By contrast, patients and clinicians subjectively reported suboptimal disease control at lower rates than did STRIDE-II. Among patients, 12 (15.0%) of 87 with CD and 13 (18.6%) of 76 with UC self-identified as having suboptimal disease control, and clinicians reported suboptimal control in 17 (19.5%) of 87 patients with CD and in 19 (25.0%) of 76 with UC.
Improving Knowledge of STRIDE-II Targets
“Physicians and patients need to be educated about what they want to achieve,” Dr. Siffledeen notes. “Clinicians need to communicate more effectively with patients and closely monitor their progress to ensure they meet their STRIDE-II treatment targets. Applying STRIDE-II criteria is useful to identify suboptimal disease control and gaps in treatment decision-making to improve disease management and QOL.”
He acknowledges that determining whether treatment targets are being met “requires thorough, resource-consuming assessments that are often limited to specialized IBD centers.”
Further, IBD “requires frequent and broad assessments along each patient’s disease journey, including a deep dive into QOL measures.”
Additional research is needed to characterize a comprehensive and standardized treatment approach for IBD, and this research is being planned, according to Dr. Siffledeen. “This research has also been conducted in several other countries, and it will be important to examine whether achieving treatment targets varies by population and to assess factors that contribute to achieving optimal IBD management.”
