'Treat to Target' in Mild to Moderate Ulcerative Colitis: Evidence to Support this Strategy

Abstract

Background: The management of chronic conditions, above all rheumatic disease and diabetes, now incorporates a "treat to target" strategy where treatment aims to achieve objective outcomes. This is applicable in ulcerative colitis (UC) as well. Targets are demonstrated to prevent endorgan dysfunction, specifically bowel damage and its complications, and lastly colorectal cancer. Recently, the scientific community has tried to define further targets beyond those currently recommended, namely mucosal healing and clinical remission. Studies that prospectively investigated this approach in UC are scanty and a treat-to-target (T2T) algorithm is not routinely used in daily clinical practice.

Objective: We aim to review current evidence on T2T in UC and discuss its adoption in routine clinical practice as well as in clinical trials.

Methods: A PubMed search was conducted in February 2020 to identify published papers investigating targets' achievement rates in UC.

Results: Different targets can be achieved through approved drugs for mild to moderate UC; histological remission is emerging as a robust target with respect to long-term outcomes.

Conclusion: Further studies to compare a T2T strategy with the traditional care are needed, particularly in the mild to moderate spectrum of disease.

Trial registration: ClinicalTrials.gov NCT04340895.

Keywords: Ulcerative colitis; histological healing; inflammation; mucosal healing; remission; target.