Treat to target in Crohn’s disease: A practical guide for clinicians

Table 1 Time to treatment targets based on Crohn’s disease therapy

	Mean time to treatment target (wk)1
	Clinical response	Clinical remission	Normalisationof CRP	Decrease in calprotectin	Endoscopic healing
Anti-TNF	2-4[4]	4-6[4]	9[4]	11[4]	17[4]
Adalimumab	2-4[114]	4[114]	-	-	12[114]
Infliximab	2-4[115,116]	4-6[4]	-	-	24[117,118]
Exclusive enteral nutrition	2[119]	4-8[119-121]	5[4]	8[4]	4-8[120,121]
Methotrexate	9[122]	22[122]	14[4]	15[4]	24[4]
Oral steroids	2-4[20]	4-7[4,123]	5[4]	8[4]	-
Thiopurine	12[124]	15-18[4,125]	15[4]	17[4]	26[118]
Upadacitinib	2[126]	2-4[126]	-	-	12-16[127]
Ustekinumab	6[128]	6-8[128]	11[4]	14[4]	19[4]
Vedolizumab	6-14[129-132]	10-14[133-135]	15[4]	17[4]	22[136]

¹In the absence of high-quality data, the time to response data should only be used as a guide.

TNF: Tumour necrosis factor; CRP: C-reactive protein.

Table 2 Treatment targets defined by Selecting Therapeutic Targets in Inflammatory Bowel Disease-II for Crohn’s disease

Treatment target	Definition
STRIDE-II endorsed treatment targets in adult patients with Crohn’s disease
Clinical response	≥ 50% decrease in baseline Patient Reported Outcomes 2 (PRO2)1; (abdominal pain and stool frequency)
Clinical remission	PRO2 with abdominal pain score ≤ 1 and stool frequency score ≤ 31; or Harvey Bradshaw Index < 5
Patient reported outcomes	Clinical outcomes evaluated using PRO2; absence of disability and normalisation of health-related quality of life
Biomarker normalisation	C-reactive protein < upper limit of normal; faecal calprotectin < 250 μg/g
Endoscopic response	> 50% improvement in simple endoscopic score-Crohn’s disease score; or > 50% improvement in Crohn’s disease endoscopic index score
Endoscopic healing	Simple endoscopic score-Crohn’s disease ≤ 2; or Crohn’s disease endoscopic index score < 3; and absence of ulcers, including aphthous ulcers
Adjunctive treatment targets
Transmural healing	Adjunct to endoscopic healing to represent a deeper level of healing; assessed using intestinal ultrasound, magnetic resonance (or computed tomography) enterography; however, a consensus definition of transmural healing remains yet to be established

¹Endorsed by Selecting Therapeutic Targets in Inflammatory Bowel Disease-II recommendations.

STRIDE: Selecting Therapeutic Targets in Inflammatory Bowel Disease.