Abstract
Dear Editor,
We read with great interest the study by Al Hosani et al.[1] on STRIDE-II treatment target achievement in inflammatory bowel disease (IBD) from a center in the United Arab Emirates, recently published in this Journal. We commend the authors for showing that through personalized treatment and tight monitoring, approximately two-thirds of patients with IBD achieve deep remission, allowing them to improve their quality of life.
However, certain aspects warrant attention. Firstly, clinical remission was defined as Partial Mayo Score of 1 or less for ulcerative colitis and HarveyBradshaw Index of 4 or less for Crohn’s disease. However, fecal urgency is also a relevant parameter in the evaluation and management of IBD.[2] Given its impact on inflammatory activity and impairment of quality of life, even in patients in remission, it should also be considered when evaluating the response to different therapeutic strategies. Second, the authors do not mention whether patients with Crohn’s disease and a history of surgery for the disease were excluded from the study. Ileocecal resection can cause digestive symptoms that may affect the clinical evaluation of patients. Furthermore, in these patients, endoscopic remission should be evaluated using the Rutgeerts index (endoscopic activity: Rutgeerts score >3). Third, endoscopic remission was defined as Mayo endoscopic subscore of 0 or 1. Experience has shown that patients with Mayo endoscopic subscore of 0 have fewer inflammatory flare-ups compared to those with Mayo endoscopic subscore of 1.[3] Fourth, the authors mention only adalimumab and infliximab as anti-tumor necrosis factor therapy. Golimumab has also been approved for the treatment of ulcerative colitis. In our experience, golimumab is effective and safe for moderate UC, achieving high rates of clinical, biomarker and endoscopic remission, being a valid therapeutic option in regions with limited access.[4]
Finally, patient’s adherence to pharmacological therapy and follow up has a fundamental role in achieving the treatment targets proposed in STRIDE-II,[5] requiring education by providers and nurses specializing in IBD. Furthermore, intestinal ultrasound, a non-invasive and repeatable tool for assessing IBD, has demonstrated high levels of acceptance by patients and providers which would increase adherence to STRIDE-II recommendations.
In conclusion, the expansion of the therapeutic armamentarium and monitoring tools have facilitated the implementation of a treat-to-target strategy and a more personalized, goal-directed therapeutic approach in patients with IBD.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
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