{
  "abstract": "Introduction Treat-to-target (T2T) strategies have improved outcomes in luminal inflammatory bowel disease; however, perianal Crohn’s disease (pCD) has distinct treatment goals and lacks a dedicated framework. We aimed to develop international, multidisciplinary T2T recommendations specific to pCD.Methods The TOpClass Consortium conducted a modified Delphi consensus process, supported by an updated systematic review of pCD outcome measures. An international clinician survey (Oct 2025) used open-ended questions to elicit proposed early, intermediate and late treatment targets. A multidisciplinary steering group analysed responses for frequency, relevance and clinical feasibility. Findings were explored with patients via a focus group (Nov 2025) to identify alignment and divergence in priorities. A patient survey (Dec 2025–Jan 2026) further evaluated preferences using ranking exercises and sliding-scale ratings across pCD phenotypes. A second clinician survey is underway to refine draft frameworks, with final recommendations to be agreed at a multidisciplinary workshop. Ethical approval: IRAS 335652.Results A total of 161 clinicians, including gastroenterologists, surgeons, radiologists and IBD nurses, completed the first-round survey. Responses demonstrated a stage-specific approach to defining treatment targets. Early goals focused on symptom response and sepsis control, whereas late targets centred on symptom resolution, external opening closure (re-epithelialisation) and radiological healing ( figure 1). Seton removal and radiological improvement were most commonly proposed as intermediate targets. When clinicians were asked to identify primary targets, only a minority endorsed complete MRI fistula closure (46.2%), while improved quality of life (QoL) ranked highest. These findings aligned with patient perspectives from the focus group, in which full fistula closure was not considered essential if symptoms are controlled and QoL improved. In the patient survey (n=51), relief of pain and discharge ranked highest, followed by improved QoL and functioning, while complete fistula closure and seton removal ranked lowest.Conclusions Preliminary consensus suggests that T2T strategies in pCD should prioritise symptom control, sepsis management and QoL over radiological endpoints alone. These findings challenge conventional clinical trial definitions of success and will inform development of a clinically relevant, staged T2T framework. Final international consensus recommendations will be completed prior to conference presentation.Abstract O26 Figure 1Frequency of clinician-suggested targets across early, intermediate (mid) and late treatment stages",
  "authors": [
    {
      "affiliations": [
        "Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom",
        "Department of Gastroenterology, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "Luke Hanna"
    },
    {
      "affiliations": [
        "Department of Surgery, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "Shivani Joshi"
    },
    {
      "affiliations": [
        "Patient Representative, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "Rachel Capstick"
    },
    {
      "affiliations": [
        "Patient Representative, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "James Ramsden"
    },
    {
      "affiliations": [
        "Paediatric Gastroenterology, BC Children’s Hospital & University of British Columbia, Vancouver, Canada"
      ],
      "name": "Sally Lawrence"
    },
    {
      "affiliations": [
        "Department of Surgery, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "Denise Robinson"
    },
    {
      "affiliations": [
        "Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom",
        "Department of Gastroenterology, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "James Alexander"
    },
    {
      "affiliations": [
        "Department of Surgery, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "Kapil Sahnan"
    },
    {
      "affiliations": [
        "Department of Surgery, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "Janindra Warusavitarne"
    },
    {
      "affiliations": [
        "IBD Service, Liverpool Hospital & University of New South Wales Sydney, Sydney, Australia"
      ],
      "name": "Susan Connor"
    },
    {
      "affiliations": [
        "Department of Radiology, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "Phillip Lung"
    },
    {
      "affiliations": [
        "Department of Surgery, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "Phil Tozer"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, St Mark’s Hospital & Academic Institute, London, United Kingdom"
      ],
      "name": "Ailsa Hart"
    }
  ],
  "title": "O26 Developing a treat-to-target framework for perianal crohn’s disease: an international initiative from the TOpClass consortium",
  "uid": "d00db6dc-d89c-5296-bb2f-5a855d566e64"
}