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Ann Rheum Dis doi:10.1136/annrheumdis-2013-205139
  • Recommendation

Treat-to-target in systemic lupus erythematosus: recommendations from an international task force

  1. Matthias Schneider37
  1. 1Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases, Stockholm, Sweden, Karolinska Institutet, Stockholm, Sweden
  2. 2Rheumatology Unit, University of Pisa, Pisa, Italy
  3. 3Department of Internal Medicine, University of Crete, Heraklion, Greece
  4. 4Division of Medicine, UCL, Centre for Rheumatology Research, London, UK
  5. 5Department of Dermatology, University of Muenster, Muenster, Germany
  6. 6Department of Dermatology, Lupus Europe, Romford, UK
  7. 7Medical Faculty, Department of Internal Medicine III, Technical University of Dresden, Dresden, Germany
  8. 8Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  9. 9Department of Medicne/Rheumatology-Clinical Immunology, University of Crete, Heraklion, Greece
  10. 10Arc Epidemiology Unit, University of Manchester, Manchester, UK
  11. 11Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
  12. 12Division of Clinical Epidemiology, McGill University, Montreal, Canada
  13. 13Service de Médicine Interne 2, Hôpital Pitié-Salpêtrière, Paris, France
  14. 14Department of Rheumatology and Immunology, University of Pecs, Pecs, Hungary
  15. 15Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands, Utrecht, The Netherlands
  16. 16Department of Medicne/Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany
  17. 17Rheumatology Research Group, Birmingham University Medical School, Birmingham, West Midlands, UK
  18. 18Department of Internal Medicine, Medical University of Graz, Graz, Austria
  19. 19Department of Rheumatology, Université Catholique de Louvain, Bruxelles, Belgium
  20. 20Department of Internal Medicine, Istanbul University, Istanbul, Turkey
  21. 21Department of Rheumatology—4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  22. 22Department of Medicine, Addenbrooke's Hospital, Cambridge, UK
  23. 23Institute of Rheumatology, Warsaw, Poland
  24. 24Discipline of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
  25. 25Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Le Kremlin—Bicêtre, France
  26. 26Southern Clinical School, Monash University, Clayton, Victoria, Australia
  27. 27Rheumatology Department, University of Santo Tomas Hospital, Manila, Philippines
  28. 28Med. Abteilung für Nephrologie und Dialyse, Wilhelminenspital, Wien, Austria
  29. 29Department of Rheumatology, University College London, London, UK
  30. 30National Institute for Rheumatic Diseases, Piestany, Slovakia
  31. 31Department of Rheumatology, Medical University of Vienna, Vienna, Austria
  32. 32Unidade Imunologia Clínica, Department of Medicine, Hospital Santo António, Porto, Portugal
  33. 33Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
  34. 34Department of Rheumatology, Odense University Hospital, Odense, Denmark
  35. 35Department of Nephrology, Moscow State Medicine and Dentistry University, Moscow, Russian Federation
  36. 36Lanarkshire Centre for, East Kilbride, UK
  37. 37Department of Rheumatology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
  1. Correspondence to Dr Ronald van Vollenhoven, Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases, Stockholm, Sweden, Karolinska Institutet, Stockholm 17176, Sweden; ronald.van.vollenhoven{at}ki.se
  • Received 23 December 2013
  • Revised 22 March 2014
  • Accepted 23 March 2014
  • Published Online First 16 April 2014

Abstract

The principle of treating-to-target has been successfully applied 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 healthcare providers and administrators. Thus, an initiative to evaluate possible therapeutic targets and develop treat-to-target guidance was believed to be highly appropriate in the management of systemic lupus erythematosus (SLE) patients as well. Specialists in rheumatology, nephrology, dermatology, internal medicine and clinical immunology, and a patient representative, contributed to this initiative. The majority convened on three occasions in 2012–2013. Twelve topics of critical importance were identified and a systematic literature review was performed. The results were condensed and reformulated as recommendations, discussed, modified and voted upon. The finalised bullet points were analysed for degree of agreement among the task force. The Oxford Centre level of evidence (LoE, corresponding to the research questions) and grade of recommendation (GoR) were determined for each recommendation. The 12 systematic literature searches and their summaries led to 11 recommendations. Prominent features of these recommendations are targeting remission, preventing damage and improving quality of life. LoE and GoR of the recommendations were variable but agreement was >0.9 in each case. An extensive research agenda was identified, and four overarching principles were also agreed upon. Treat-to-target-in-SLE (T2T/SLE) recommendations were developed by a large task force of multispecialty experts and a patient representative. It is anticipated that ‘treating-to-target’ can and will be applicable to the care of patients with SLE.

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