Updated treatment targets in inflammatory bowel disease (STRIDE-III): an initiative of the International Organization for the Study of IBD

Since Selecting Therapeutic Targets in Inflammatory Bowel Disease-II (STRIDE-II), new evidence has become available across inflammatory and patient-centred outcomes.

We aimed to update the STRIDE recommendations for Crohn's disease and ulcerative colitis. We searched MEDLINE, Embase, and Cochrane CENTRAL for studies published after the STRIDE-II search period.

Findings were integrated with surveys of International Organization for the Study of IBD (IOIBD) members and paediatric gastroenterologists from the Porto group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Statements were subsequently voted on using a modified Delphi approach; consensus was defined as ≥75% of participants rating a statement 7-10 on a 10-point scale.

Of 13 071 records identified in the systematic review, 1018 were included. Surveys were completed by 60 of 79 IOIBD gastroenterologists and 23 of 30 paediatric gastroenterologists in the Porto group.

STRIDE-III defines three conceptually distinct categories of treatment targets. Actionable targets include clinical response and remission, which reflect patient priorities, and objective inflammatory targets (C-reactive protein normalisation, faecal calprotectin within target range, and endoscopic remission), supported by interventional evidence demonstrating benefits of target-guided treatment modification.

Adjunctive targets (ie, urgency, histological remission in ulcerative colitis, transmural remission in Crohn's disease, and growth) are supported by studies showing association with favourable outcomes and guide treatment optimisation and tighter monitoring but do not necessarily require a change in therapeutic class.

Patient-centred targets (ie, disability, fatigue, and quality of life) directly reflect patients' well-being and are impaired in a substantial proportion of patients with inflammatory bowel disease; impairment should prompt assessment of inflammation and alternative causes and management through shared decision-making. Targets are further classified as immediate, short-term, intermediate, and long-term.

STRIDE-III also defines treatment-specific times to target achievement, new faecal calprotectin thresholds, and adaptations for resource-limited settings. STRIDE-III distinguishes targets that should prompt treatment change from those that primarily guide optimisation and monitoring, while establishing a separate patient-centred pathway based on shared decision-making.

This framework supports consistent, evidence-based treat-to-target care.