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Publications

Journal Article Review Ahead of print

PubMed: 42829018 DOI: 10.1016/j.cgh.2026.09.033

TREAT-TO-TARGET IN INFLAMMATORY BOWEL DISEASE: PROMISE, PERILS, AND THE PATH FORWARD.

Clin Gastroenterol Hepatol

Authors: Siddharth Singh, Olga Maria Nardone, Mariangela Allocca, Yuhong Yuan, Jakob Begun, Jason K Hou, Mohammad Shehab, Taku Kobayashi, Vineet Ahuja, Axel Dignass, Vipul Jairath

Affiliations

  • Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
  • Gastroenterology Unit, Department of Public Health, University of Naples Federico II, Naples, Italy.
  • IRCCS Ospedale San Raffaele, Gastroenterology and Endoscopy, Milan, Italy; Medicine and Surgery Department, Vita-Salute San Raffaele University, Milan, Italy.
  • Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada.
  • Mater Research Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia.
  • Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
  • Program of Medicine, College of Medicine and Health Sciences, Abdullah Al Salem University, Khaldiya, Kuwait.
  • Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
  • Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
  • Department of Medicine I, Agaplesion Markus Hospital, Goethe University, Frankfurt, Germany.
  • Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.

Abstract

Treat-to-target has become the organising framework for contemporary inflammatory bowel disease (IBD) management, yet its evidence base is less robust than its widespread endorsement might suggest. The approach rests on two equally essential pillars: defining the right therapeutic target, and adjusting treatment iteratively until that target is achieved. Over the past decade, the first pillar has advanced substantially: targets have deepened from symptomatic remission through endoscopic and histologic healing toward transmural and emerging molecular endpoints, supported largely by association data linking deeper remission to better long-term outcomes. The second pillar has received considerably less scrutiny. Completed randomised trials of iterative treatment adjustment have yielded mixed results in unselected populations, real-world monitoring remains inconsistent, and the most clinically pressing question, whether asymptomatic patients with residual inflammation benefit from optimising or switching advanced therapies, remains unanswered. In this review, we critically examine both pillars: the evolution and evidence base for treatment targets in IBD, the ability of current therapies to achieve them, the lessons from pivotal treat-to-target trials, and the barriers to real-world implementation. We propose a framework for individualising treat-to-target decisions based on disease history, inflammatory trajectory, therapeutic options, and patient preferences. Ongoing trials including QUOTIENT, VERDICT, and VECTORS may define whether the second pillar can be placed on as firm a footing as the first.

MeSH

Inflammatory Bowel Diseases, Therapeutics