Background In order to develop “treat-to-target” recommendations for SLE, a panel of experts identified topics related to the treatment of the disease and commissioned a systematic literature search.
Objectives To provide the literature-based evidence for treat-to-target recommendations in SLE.
Methods Twelve topics were identified and a systematic PubMed search was performed using an array of keywords (Table 1). Out of 9278 articles identified initially, 440 were selected for further review. Evidence was categorized based on sample size, study design, and estimated effect sizes.
Results SLE disease activity (both global and organ-specific) is associated with accrual of organ damage and mortality, and shows modest inverse association with quality of life (QoL). In lupus nephritis, achieving complete renal response is associated with good prognosis. Only a fraction (10-40%) of patients can achieve long-lasting disease remission, and major SLE flares, particularly renal disease flares, are associated with adverse outcomes. Organ damage accrual is a poor prognostic factor and shows modest association with QoL. The long-term benefits and risks of treating asymptomatic but serologically active patients have not been established. In active renal or inflammatory neurological disease, the combination of immunosuppressives with glucocorticoids is superior to glucocorticoids alone as induction treatment. In lupus nephritis, long-term maintenance immunosuppressive treatment may prevent renal flares and improve outcome. In chronic SLE treatment, higher cumulative doses of glucocorticoids are associated with damage accrual. In antiphospholipid syndrome, there is limited evidence for superiority of variable intensity anticoagulation regimens. Non-randomized evidence suggests that use of antimalarials is associated with reduced damage accrual. Adjunctive therapies are safe in lupus although there is no evidence for association with improved long-term outcomes.
Conclusions A systematic literature review yielded a large set of data to be considered by the treat-to-target working party for further development.
Disclosure of Interest G. Bertsias: None Declared, M. Mosca: None Declared, A. Levitsky: None Declared, R. Van Vollenhoven Grant/research support from: AbbVie, BMS, GSK, MSD, Pfizer, Roche, UCB, Consultant for: AbbVie, BMS, GSK, MSD, Pfizer, Roche, UCB