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

Gastroenterology. 2021 Apr;160(5):1570-1583. doi: 10.1053/j.gastro.2020.12.031. Epub 2021 Feb 19.


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.

Keywords: Biologics; Biomarkers; Endoscopic Healing; Patient-Reported Outcomes; Treat-to-Target.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Adolescent Development
  • Adult
  • Age Factors
  • Biomarkers / metabolism
  • Child
  • Child Development
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / immunology
  • Colitis, Ulcerative / therapy*
  • Consensus
  • Crohn Disease / diagnosis
  • Crohn Disease / immunology
  • Crohn Disease / therapy*
  • Delphi Technique
  • Endpoint Determination*
  • Humans
  • Quality of Life
  • Remission Induction
  • Research Design*
  • Treatment Outcome
  • Wound Healing


  • Biomarkers

Supplementary concepts

  • Pediatric Crohn's disease
  • Pediatric ulcerative colitis