Background The principle of “treating-to-target” has been applied successfully to many diseases outside rheumatology and more recently to rheumatoid arthritis. Identifying appropriate therapeutic targets and pursuing these systematically has led to improved care for patients with these diseases and useful guidance for health care providers and administrators. Thus, an initiative to develop treat-to-target guidance was believed to be of benefit in SLE as well.
Objectives To derive Treat-to-target guidance for SLE.
Methods Thirty-four specialists in rheumatology, nephrology, dermatology and/or clinical immunology and a patient representative contributed to this initiative. The majority convened on three occasions. During the first meeting, the broad outlines of the project were discussed and agreed upon. During the second meeting, 12 topics of critical importance for this endeavor were identified. Subsequently, a systematic literature review was performed on those topics. The results of this search were condensed and reformulated as ‘bullet points’ or, alternatively, as items for a research agenda. At the third meeting, these bullet points were discussed, modified, and voted upon. A set of overarching principles was also developed and agreed upon. These results were further discussed during two telephone conferences. In the spring of 2013 the final bullet points will be circulated and degrees of agreement will be evaluated.
Results The twelve systematic literature searches and their summaries led to ten bullet points which were extensively discussed, modified and voted upon. Broad agreement (>90% in favor) was reached for all but one bullet point. The bullet points include specified targets of remission for lupus nephritis and for at least some patients with non-renal lupus; the importance of disease control, reduction of flares, and prevention of disease-related damage; the need to use validated instrument for defining the target and to ensure assessment of the target at follow up; special consideration of health-related quality-of-life as a target distinct from inflammatory control; appropriate use of the therapeutic categories used for SLE including glucocorticoids, antimalarials, and immunomodulatory/immunosuppressive medications; and consideration of comorbidities. Four overarching principles were agreed upon, and an extensive research agenda was also identified.
Conclusions The groundwork for a treat-to-target-in-SLE (T2T/SLE) document was prepared including recommendations agreed upon by a large panel of multi-specialty experts and patient representative. It is anticipated that “treating-to-target” can and will be applicable to the care of patients with SLE.
Disclosure of Interest None Declared