Gastroenterologists' attitudes and challenges toward treat-to-target strategies in inflammatory bowel disease: a multinational survey.

Background: To standardize the treatment of inflammatory bowel disease (IBD) by establishing clear treatment targets and optimizing management strategies, the International Organization for the Study of IBD has proposed a treat-to-target (T2T) approach, which is now a popular management paradigm for IBD. However, this paradigm, which was derived primarily from Western countries with a high prevalence of IBD, has not been adopted universally. There is limited information on how T2T strategies are implemented around the world, and particularly in countries where IBD is a more recent phenomenon and has lower prevalence. Objectives: The aim of this study was to take advantage of the existence of the BRICS IBD Consortium (Brazil, Russia, India, China, and South Africa), a newly formed multinational organization, to get a realistic appraisal of gastroenterologists' attitudes concerning the IBD treatment strategies. Design: A 59-question online questionnaire was distributed to 227 gastroenterologists from the BRICS countries between February and April 2024. Methods: Data on gastroenterologists' characteristics, treatment strategies, and adoption of the STRIDE (Selecting Therapeutic Targets in Inflammatory Bowel Disease)-II consensus were collected, focusing primarily on viewpoints and challenges toward IBD T2T strategies. Results: More than 70% of respondents considered clinical and endoscopic remission, improved quality of life, absence of disability, and restoration of normal growth in children as the most important goals for IBD treatment. Concerns and challenges raised toward the International Organization for the Study of IBD (IOIBD) T2T strategy were the lack of a validated definition of mucosal healing (66.1%), guidelines conflicted with clinical experience (40.1%), psychological comorbidities (89.4%), loss of response to medical therapy (74.9%), complications associated with penetrating Crohn's disease (CD; 74%), fistulising perianal CD (67.4%), and high out-of-pocket costs of therapeutic drug monitoring (69.6%). A step-up strategy was preferred (89%) in mild-to-moderate ulcerative colitis, whereas a top-down strategy was selected by the majority (72.2%) of respondents for CD management. Overall, the BRICS survey indicated that most of the participants had relatively high confidence in the IOIBD T2T recommendations. Conclusion: Although various concerns were identified, the BRICS survey showed that T2T strategies for IBD have been generally well received but not universally adopted by most gastroenterologists in countries with the more recent emergence of IBD.