Consensus recommendations for the implementation of treat-to-target strategies in SLE

Treat-to-target (T2T) is an emerging strategy in SLE management, aimed at achieving remission or low disease activity to improve long-term outcomes.¹ Although these goals are widely endorsed, real-world adoption of T2T remains limited, largely due to a lack of practical guidance and tools to support implementation in routine practice.¹

A T2T task force comprised of 22 physicians and 3 patient research partners met to develop a practical framework for implementing T2T strategies in routine SLE care.¹ The 5 overarching principles and 11 consensus statements outlined by the task force were published by Piga et al. in Autoimmunity Reviews.¹ The framework aims to bridge the gap between theoretical guidelines and real-world clinical application.¹

Key learnings¹

The overarching principles for implementing T2T in SLE emphasize early treatment initiation, clinical guideline adherences, shared decision-making, integration of non-pharmacological strategies, and the use of telehealth and digital tools.

The consensus statements recommend aiming for early remission, with individual timelines based on disease type and treatment adjustments if targets are not met. Regular follow-ups, prompt management of flares, and ongoing assessment of adherence and response to treatment are essential.

Prednisone should be reduced to 5 mg/day within a designated time while aiming for remission, with shared decision-making and individualized care plans implemented when considering tapering or discontinuing glucocorticoids and DMARDs in stable patients. 

This framework differs significantly from current EULAR and GLADEL/PANLAR recommendations and provides a strategy for the effective implementation of T2T in clinical practice, informing a wide range of physicians as well as lupus specialists.