BACKGROUND AND AIMS Management of Crohn's disease and ulcerative colitis has typically relied upon treatment intensification driven by symptoms alone. However, a 'treat-to-target' management approach may help to address underlying inflammation, minimise disease activity at early stages of inflammatory bowel disease, limit progression, and improve long-term outcomes. METHODS A systematic literature review was conducted to identify data relevant to a treat-to-target approach in inflammatory bowel disease, published between January 1, 2007 and May 15, 2017. RESULTS Consistent with recommendations of the Selecting Therapeutic Targets in Inflammatory Bowel Disease [STRIDE] working group, studies have investigated factors influencing the achievement of both endoscopic and histological mucosal healing and patient-level outcomes in inflammatory bowel disease [IBD]. Histological healing and biomarker levels have also been shown to be modifiable outcomes. Although there is a lack of prospectively derived evidence validating mucosal healing as a treatment target, data are emerging to suggest that targeting mucosal healing or inflammation rather than symptoms may be cost-effective in some settings. The review highlighted several strategies that may support the implementation of a treat-to-target approach in IBD. The prospective randomised CALM study demonstrated how tight control [whereby treatment decisions are based on close monitoring of inflammatory biomarkers] leads to improvements in endoscopic and clinical outcomes. The review also considered the influence of coordinated care from a multidisciplinary team and patient engagement with improved adherence, as well as the role of therapeutic drug monitoring in inflammatory bowel disease management. CONCLUSIONS A treat-to-target strategy may impact on disease progression and improve outcomes in inflammatory bowel disease. Prospective studies including long-term data are required to ensure that the most appropriate targets and strategies are identified.

中文翻译：

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支持炎症性肠病靶向治疗方法的结果和策略：系统评价。

背景和目的克罗恩病和溃疡性结肠炎的治疗通常依赖于仅由症状驱动的治疗强化。然而，“目标治疗”管理方法可能有助于解决潜在的炎症，最大限度地减少炎症性肠病早期阶段的疾病活动，限制进展并改善长期结果。方法 对 2007 年 1 月 1 日至 2017 年 5 月 15 日发表的炎症性肠病靶向治疗方法进行系统性文献综述，以确定相关数据。结果与选择炎症性肠病治疗靶点的建议一致[ STRIDE] 工作组的研究调查了影响炎症性肠病 [IBD] 内镜和组织学粘膜愈合以及患者水平结果的因素。组织学愈合和生物标志物水平也被证明是可改变的结果。尽管缺乏前瞻性证据来验证粘膜愈合作为治疗目标，但不断出现的数据表明，在某些情况下，针对粘膜愈合或炎症而不是症状可能具有成本效益。该审查强调了可能支持在 IBD 中实施治疗目标方法的几种策略。前瞻性随机 CALM 研究证明了严格控制（基于对炎症生物标志物的密切监测来做出治疗决策）如何改善内镜和临床结果。该综述还考虑了多学科团队协调护理的影响和患者参与对依从性的提高，以及治疗药物监测在炎症性肠病管理中的作用。结论 靶向治疗策略可能会影响疾病进展并改善炎症性肠病的预后。需要进行包括长期数据在内的前瞻性研究，以确保确定最合适的目标和策略。