Points-to-consider for T2T in cSLE
| Points-to-consider | Agreement (%) | LOE | GOR |
| 1. The treatment target of cSLE should be disease remission. | 87 | 3 | C |
| 2. In patients where remission cannot be achieved, low disease activity is an alternative target. | 100 | 3 | C |
| 3. Prevention of flares should be targeted, as an important therapeutic goal | 100 | 2 | B |
| 4. Patients with clinically inactive disease and persistent low complement and/or elevated anti-ds-DNA antibody titres require close monitoring. Therapy should not be escalated solely on these results. | 100 | 3 | C |
| 5. Prevention of organ damage accrual, measured using a validated SLE damage index, should be a major therapeutic goal in cSLE. | 100 | 2 | B |
| 6. Factors influencing HRQOL, such as fatigue, pain, mental health, educational challenges, and medication side effects should be proactively addressed, through a multidisciplinary approach. | 94 | 3 | C |
| 7. Early recognition and treatment of renal involvement is strongly recommended. | 100 | 3 | C |
| 8. In patients with histologically proven class III, IV and/or V lupus nephritis, following induction therapy, a period of immunomodulatory maintenance therapy lasting at least 3 years is recommended. | 94 | 3 | D |
| 9. Maintenance treatment should aim for the lowest glucocorticoid dosage needed to control disease, through optimisation of immunomodulatory therapy. | 100 | 2 | C |
| 10.Prevention and treatment of antiphospholipid antibody related morbidity should be a long-term therapeutic goal. | 100 | 3 | C |
| 11.All patients should be prescribed hydroxychloroquine routinely, unless there are contraindications. | 94 | 2 | B |
| 12.Prevention and control of comorbidities should be a treatment target. | 94 | 4 | D |
| 13.Frequent assessment is recommended to ensure the patient is on the correct trajectory to achieve their target, using standardised assessment tools. | 100 | 4 | D |
| 14.Once the target has been achieved, it should be sustained. Ongoing monitoring should occur to ensure maintenance of the target. | 100 | 3 | C |
During the discussion of points-to-consider 1–5 and 14, one or two task force participants were absent from the on-line meeting due to urgent commitments. Each point-to-consider was graded for the LOE on a scale of 1–4, and the GOR on a scale from A (highest) to D (lowest), in accordance with EULAR standardised operating procedures for EULAR-endorsed recommendations.26 LOE 1A: From meta-analysis of randomised controlled trials, 1B: From at least one randomised controlled trial, 2A: From at least one controlled study without randomisation, 2B: From at least one type of quasi-experimental study, 3: From descriptive studies, such as comparative studies, correlation studies or case–control studies, 4: From expert committee reports or opinions and/or clinical experience of respected authorities. GOR A: directly based on category I evidence, B: directly based on category II evidence or extrapolated points-to-consider from category I evidence, C: directly based on category III evidence or extrapolated points-to-consider from category I or II evidence, D: directly based on category IV evidence or extrapolated point-to-consider from category II or III evidence. Agreement (%) indicates percent of experts agreeing on the point-to-consider during the final voting round of the consensus meeting.27
cSLE, childhood-onset systemic lupus erythematosus; GOR, grade of the ensuing point-to-consider; HRQOL, health-related quality of life; LOE, level of evidence; T2T, treat-to-target.