Treat to target in mild to moderate ulcerative colitis: evidence to support this strategy

BACKGROUND The management of chronic conditions, above all rheumatic disease and diabetes has adopted a 'treat to target' strategy where treatment aims to achieve objective outcomes; this has emerged as applicable in ulcerative colitis (UC) as well. Targets are demonstrated to prevent end-organ disfunction, specifically bowel damage and its complications, 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 inserted in daily clinical practice. OBJECTIVE We aim to review current evidence on T2T in UC and to 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 to the traditional care are needed, particularly in the mild to moderate spectrum of disease.