Remembering Professor FENG PAO HSII
Treat-to-target in systemic lupus erythematosus: overarching principles and bullet points
Overarching principle 1: The management of systemic lupus erythematosus (SLE) should be based on shared decisions between the informed patient and her/his physician(s).
Overarching principle 2: Treatment of SLE should aim at ensuring long-term survival, preventing organ damage, and optimising health-related quality-of-life, by controlling disease activity and minimising comorbidities and drug toxicity.
Overarching principle 3: The management of SLE requires an understanding of its many aspects and manifestations, which may have to be targeted in a multidisciplinary manner.
Overarching principle 4: Patients with SLE need regular long-term monitoring and review and/or adjustment of therapy.
The treatment target of SLE should be remission of systemic symptoms and organ manifestations or, where remission cannot be reached, the lowest possible disease activity, measured by a validated lupus activity index and/or by organ-specific markers.
Prevention of flares (especially severe flares) is a realistic target in SLE and should be a therapeutic goal.
It is not recommended that the treatment in clinically asymptomatic patients be escalated based solely on stable or persistent serological activity.
Since damage predicts subsequent damage and death, prevention of damage accrual should be a major therapeutic goal in SLE.
Factors negatively influencing health-related quality of life (HRQOL), such as fatigue, pain and depression should be addressed, in addition to control of disease activity and prevention of damage.
Early recognition and treatment of renal involvement in lupus patients is strongly recommended.
For lupus nephritis, following induction therapy, at least 3 years of immunosuppressive maintenance treatment is recommended to optimise outcomes.
Lupus maintenance treatment should aim for the lowest glucocorticoid dosage needed to control disease, and if possible, glucocorticoids should be withdrawn completely.
Prevention and treatment of antiphospholipid syndrome (APS)-related morbidity should be a therapeutic goal in SLE; therapeutic recommendations do not differ from those in primary APS.
Irrespective of the use of other treatments, serious consideration should be given to the use of antimalarials.
Relevant therapies adjunctive to any immunomodulation should be considered to control comorbidity in SLE patients.