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Towards development of treat to target (T2T) in childhood-onset systemic lupus erythematosus: PReS-endorsed overarching principles and points-to-consider from an international task force.

Authors :
Smith EMD
Aggarwal A
Ainsworth J
Al-Abadi E
Avcin T
Bortey L
Burnham J
Ciurtin C
Hedrich CM
Kamphuis S
Levy DM
Lewandowski LB
Maxwell N
Morand EF
Ozen S
Pain CE
Ravelli A
Saad Magalhaes C
Pilkington CA
Schonenberg-Meinema D
Scott C
Tullus K
Beresford MW
Source :
Annals of the rheumatic diseases [Ann Rheum Dis] 2023 Jun; Vol. 82 (6), pp. 788-798. Date of Electronic Publication: 2023 Jan 10.
Publication Year :
2023

Abstract

Objectives: Application of 'treat-to-target' (T2T) in childhood-onset systemic lupus erythematosus (cSLE) may improve care and health outcomes. This initiative aimed to harmonise existing evidence and expert opinion regarding T2T for cSLE.<br />Methods: An international T2T Task Force was formed of specialists in paediatric rheumatology, paediatric nephrology, adult rheumatology, patient and parent representatives. A steering committee formulated a set of draft overarching principles and points-to-consider, based on evidence from systematic literature review. Two on-line preconsensus meeting Delphi surveys explored healthcare professionals' views on these provisional overarching principles and points-to-consider. A virtual consensus meeting employed a modified nominal group technique to discuss, modify and vote on each overarching principle/point-to-consider. Agreement of >80% of Task Force members was considered consensus.<br />Results: The Task Force agreed on four overarching principles and fourteen points-to-consider. It was agreed that both treatment targets and therapeutic strategies should be subject to shared decision making with the patient/caregivers, with full remission the preferred target, and low disease activity acceptable where remission cannot be achieved. Important elements of the points-to-consider included: aiming for prevention of flare and organ damage; glucocorticoid sparing; proactively addressing factors that impact health-related quality of life (fatigue, pain, mental health, educational challenges, medication side effects); and aiming for maintenance of the target over the long-term. An extensive research agenda was also formulated.<br />Conclusions: These international, consensus agreed overarching principles and points-to-consider for T2T in cSLE lay the foundation for future T2T approaches in cSLE, endorsed by the Paediatric Rheumatology European Society.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Details

Language :
English
ISSN :
1468-2060
Volume :
82
Issue :
6
Database :
MEDLINE
Journal :
Annals of the rheumatic diseases
Publication Type :
Academic Journal
Accession number :
36627168
Full Text :
https://doi.org/10.1136/ard-2022-223328