FRAMEWORK FOR IMPLEMENTING TREAT-TO-TARGET IN SYSTEMIC LUPUS ERYTHEMATOSUS ROUTINE CLINICAL CARE: CONSENSUS STATEMENTS FROM AN INTERNATIONAL TASK FORCE. Article Swipe
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· 2025
· Open Access
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· DOI: https://doi.org/10.3899/jrheum.2025-0390.o034
· OA: W4410715702
O034 / #681 Topic: AS09 - Emerging Approaches in SLE Management ABSTRACT CONCURRENT SESSION 05: EMERGING INSIGHTS ON THE MANAGEMENT OF LUPUS MANIFESTATIONS AND COMORBIDITIES 23-05-2025 1:40 PM - 2:40 PM Background/Purpose The adoption of Treat-to-Target (T2T) in routine clinical care for systemic lupus erythematosus (SLE) is limited, with evidence showing ongoing overuse of glucocorticoids (GCs) and inadequate disease control in many patients. An international task force convened to address the challenges and identify effective strategies for implementing T2T in adult SLE patients in real-life settings. Methods The T2T task force comprised a multidisciplinary panel of 22 physicians with extensive experience in SLE management and 3 lupus patient research partners. The panel’s geographical distribution included 9 (40.9%) experts from Europe, 4 (16.5%) from Asia-Pacific, 3 (13.6%) from North America, 3 (13.6%) from Latin America, and 3 (13.6%) from Africa. Through a scoping review and online discussions, the panel mapped, identified, and discussed the current limitations and best available options for implementing T2T in SLE. Drawing from these findings, the panel formulated a series of potential framework statements, which were rigorously debated and refined before reaching an agreement through a Delphi consensus process. Results The resulting framework outlines 5 overarching principles and 11 specific statements (Table). The T2T strategy should be implemented as early as possible during the disease course, favored by a shared decision-making approach and by including nonpharmacological measures and telehealth in the process. The importance of achieving remission within a prespecified timeframe is highlighted. At the same time, LLDAS is highlighted as a valuable alternative target when remission cannot be achieved or maintained. The task force suggests time intervals between visits, guided by disease activity status. If remission is not attained within the recommended timeframe, adherence to therapy should be evaluated, and treatment strategies should be optimized accordingly. At each clinical visit, prioritizing the tapering of glucocorticoids is essential, with complete discontinuation considered for patients in sustained remission, ideally by following a slow tapering protocol. Prolonged remission, defined as remission lasting 5 years or longer, opens the possibility of discontinuing immunosuppressants and/or biologics in patients who have successfully discontinued glucocorticoids. Goals, priorities, and areas of investigation for future research endeavors were identified (Figure). Table. Figure. Conclusions Although formal evidence proving the superiority of T2T to conventional SLE management is lacking, the approach has been recommended for over a decade due to its potential to standardize care and improve patient outcomes. This framework represents a practical, consensus-driven tool for implementing T2T in real-world SLE management. It is designed to guide a broad spectrum of healthcare providers, including those beyond the specialized circle of lupus experts, in delivering structured, goal-oriented care to their patients.
