Bringing STRIDE2 to Life in Clinical Practice

Abstract

STRIDE (Selecting Therapeutic Targets in Inflammatory Bowel Disease [IBD]) is an initiative by the International Organisation for the Study of IBD that aims to delineate a core set of therapeutic targets for IBD based on literature review and expert consensus. The first iteration was published in 2015, with an update in 2021 (STRIDE2), which qualifies targets as short-, intermediate- or long-term and adds pediatric-specific targets.

The goal of treating any disease is to allow patients to feel well and to enjoy good quality of life (QOL), while avoiding disease- and treatment-related complications. The inflammatory bowel diseases, Crohn’s disease (CD) and ulcerative colitis (UC), are no exception. Given this overarching objective, it is not surprising that the traditional target in treating IBD has been symptom resolution, while avoiding corticosteroids. The challenge is that symptom control neither guarantees the absence of intestinal inflammation in a cross-sectional fashion, nor prevents progression to “damage” (including, for example, fibrosis, strictures and fistulae). This does not imply that symptom alleviation is irrelevant; it is a necessary, but insufficient treatment target. STRIDE2 includes clinical response (immediate/short-term) and clinical remission (intermediate) as treatment targets, but the method of symptom assessment has shifted from the physician (physician-administered clinical activity indices) to the patient (patient-reported outcomes [PROs]), aligning with the FDA’s requirement for PROs as a co-primary endpoint in clinical drug trials (typically alongside an objective disease marker such as endoscopy). STRIDE2 also introduces restoration of QOL and disability avoidance as key treatment goals. This further highlights the importance of the patient experience, and acknowledges normal linear growth as a critical pediatric-specific clinical target.