Recent treat-to-target in systemic lupus erythematosus recommendations

1. The treatment target of systemic lupus erythematosus (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.
2. Prevention of flares (especially severe flares) is a realistic target in SLE and should be a therapeutic goal.
3. It is not recommended that the treatment in clinically asymptomatic patients be escalated based solely on stable or persistent serological activity.
4. Since damage predicts subsequent damage and death, prevention of damage accrual should be a major therapeutic goal in SLE.
5. Factors negatively influencing health-related quality of life, such as fatigue, pain and depression should be addressed, in addition to control of disease activity and prevention of damage.
6. Early recognition and treatment of renal involvement in lupus patients is strongly recommended.
7. For lupus nephritis, following induction therapy, at least 3 years of immunosuppressive maintenance treatment is recommended to optimize outcomes.
8. Lupus maintenance treatment should aim for the lowest glucocorticoid dosage needed to control disease, and if possible, glucocorticoids should be withdrawn completely.
9. 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.
10. Irrespective of the use of other treatments, serious consideration should be given to the use of antimalarials.
11. Relevant therapies adjunctive to any immunomodulation should be considered to control comorbidity in SLE patients.

Source: Van Vollenhoven RF, et al. Ann Rheum Dis. 2014; 1–10. doi:10.1136/annrheumdis-2013-205139