The Impact of “Treat-to-Target” Guidelines on Disease Monitoring Activities Among Privately Insured Patients with Inflammatory Bowel Disease

Introduction: The STRIDE-I guidelines established therapeutic targets for the treatment of inflammatory bowel disease in the hope of standardizing clinical practice. STRIDE-II grouped these targets into short- (clinical response), intermediate- (normalization of laboratory markers), and long-term endpoints (improvement in endoscopic or imaging findings) and provided suggested timelines for each advanced therapy. Whether or not these guidelines actually influenced disease monitoring activities, however, remains unknown.

Methods: We identified all non-elderly adults with Crohn’s disease (CD) or ulcerative colitis (UC) who were started on a new advanced therapy from the Marketscan® Commercial Database. We then calculated the time between starting the medication and disease monitoring activities, including outpatient GI visit, C-reactive protein (CRP) or fecal calprotectin (FC) level, and either endoscopy or enterography depending on the underlying disorder. We used multivariable linear regression to compare time-to-event before and after the publication of the STRIDE-I guidelines (2015) after adjusting for demographics and healthcare utilization.

Results: We identified 32,872 CD patients and 14,081 UC patients who were started on an advanced therapy between 2008-2021. Median time to all monitoring outcomes increased over the study period, including significant increases from the pre-2015 to the post-2015 period among CD patients (+52 days to GI visit, +43 days for CRP/FC, +56 for imaging or colonoscopy; all p<0.001). Median time to event was longer than STRIDE-II recommendations for all monitoring outcomes.

Conclusion: Median time to disease monitoring activities increased between 2008-2021 despite the publication of the STRIDE guidelines. More intensive monitoring is needed to achieve “treat-to-target” guidelines.