How to use it
Choose the disease, the therapy and its start date. For each target, record Met, Not met or Not assessed. The tool dates each target from STRIDE-II’s expected time for that therapy and tells you what is due, what is overdue and what comes next.
The STRIDE-II targets
| Phase | Target | Definition (adults) |
|---|---|---|
| Short term | Clinical response | PRO2 down by at least 50% |
| Intermediate | Clinical remission | UC: rectal bleeding 0 and stool frequency 0 (or partial Mayo below 3, no subscore above 1). CD: abdominal pain ≤1 and stool frequency ≤3 (or HBI below 5) |
| Intermediate | Normal CRP, calprotectin in an acceptable range | CRP below the upper limit of normal; calprotectin 100–250 µg/g |
| Long term | Endoscopic healing | UC: Mayo endoscopic subscore 0 or UCEIS ≤1. CD: SES-CD below 3 or no ulcers |
| Long term | Quality of life and disability | Normal quality of life, no disability |
| Long term (children) | Growth | Restoration of normal growth |
Transmural healing in CD and histological healing in UC are not formal targets. STRIDE-II calls them adjuncts that show a deeper level of healing. The 2025 ECCO-ESGAR-ESP-IBUS guideline (Rec 13) goes a little further: both are prognostic, and adjusting treatment to reach them “might be considered” (expert opinion, EL5). The tool keeps the STRIDE-II target list; record either one as an extra finding if you assess it.
Expected time to target (STRIDE-II Table 4, mean weeks)
Resp = clinical response, Rem = clinical remission, CRP/ESR = normalisation of CRP or ESR, FC = calprotectin decrease, EH = endoscopic healing.
| Therapy | Resp | Rem | CRP/ESR | FC | EH |
|---|---|---|---|---|---|
| UC 5-ASA | 4 | 8 | 8 | 10 | 13 |
| UC steroids | 2 | 2 | 5 | 8 | 11 |
| UC local steroid* | 3 | 8 | 8 | 9 | 13 |
| UC thiopurine | 11 | 15 | 15 | 15 | 20 |
| UC adalimumab | 6 | 11 | 10 | 12 | 14 |
| UC infliximab | 5 | 10 | 9 | 11 | 13 |
| UC vedolizumab | 9 | 14 | 14 | 15 | 18 |
| UC tofacitinib | 6 | 11 | 9 | 11 | 14 |
| CD steroids or EEN | 2 | 4 | 5 | 8 | 13 |
| CD budesonide | 3 | 6 | 8 | 10 | 15 |
| CD thiopurine | 11 | 15 | 15 | 17 | 24 |
| CD methotrexate | 9 | 14 | 14 | 15 | 24 |
| CD anti-TNF | 2–4 | 4–6 | 9 | 11 | 17 |
| CD vedolizumab | 11 | 17 | 15 | 17 | 24 |
| CD ustekinumab | 7 | 13 | 11 | 14 | 19 |
*Budesonide MMX or beclomethasone dipropionate. EEN = exclusive enteral nutrition.
STRIDE-II says the table “should be considered merely as a rough estimate of experts’ opinion”, and it was not voted on. Where a range is given, the tool uses the upper end.
Newer drugs
STRIDE-II (2021) has no time table for golimumab, ustekinumab in UC, risankizumab, mirikizumab, guselkumab, upadacitinib, ozanimod or etrasimod. For these the tool says so and shows the trial assessment points: the weeks at which the pivotal trials measured their primary end points (for example week 8 for upadacitinib in UC, week 10 for ozanimod, week 12 for the IL-23 inhibitors). These are when trials looked, not expert estimates of when a target should be reached.
Since STRIDE-II
No STRIDE-III has been published (checked October 2026); STRIDE-II remains the IOIBD statement. Later guidance adds monitoring timelines rather than new targets:
- Check response early. ECCO-ESGAR-ESP-IBUS 2025 recommends assessing response within 12 weeks of starting or optimising therapy, clinically and biochemically, plus endoscopy or cross-sectional imaging. Intestinal ultrasound is an accepted option in both UC and CD (Rec 8, 12). In CD, assess endoscopic response within 12 months (Rec 12), and in remission monitor biomarkers and imaging every 6–12 months (Rec 14).
- Intestinal ultrasound timelines. A 2026 review mapped IUS outcomes onto STRIDE-II time points: in CD about half to two-thirds of patients had a sonographic response by week 12 but only 14–37% were in sonographic remission; in UC response and remission came earlier (weeks 8–12). Definitions vary, so use the IBUS-SAS tool and the same segment each time (Srinivasan 2026).
Pitfalls
- Mayo 0 or Mayo 1? STRIDE-II’s UC target is a Mayo endoscopic subscore of 0. ACG 2025 recommends treating to endoscopic improvement (0 or 1) and notes that 0–1 may give similar outcomes. Say which you are using in the chart.
- Before changing therapy, confirm inflammation objectively, check adherence, exclude infection and, for anti-TNF drugs, check the drug level and antibodies (see drug levels).
- Response or remission alone is not enough long term (Rec 5).
- No time frame exists in STRIDE-II for quality of life, disability or growth. Assess them at regular reviews.
- Figure versus text. STRIDE-II’s Figure 2 draws CRP normalisation with the short-term targets and growth with the intermediate ones, while the recommendations call CRP intermediate (Rec 12) and growth long term (Rec 6). The tool follows the recommendation text.