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.
Journal: Annals of the rheumatic diseases
Volume: 82
Issue: 6
Year of Publication: 2023
Affiliated Institutions:
Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK esmith@liverpool.ac.uk.
Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK.
Department of Paediatric Rheumatology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
Department of Pediatric Rheumatology and Clinical Immunology, University Medical Centre Ljubljana Division of Paediatrics, Ljubljana, Slovenia.
TARGET Lupus Public Patient Involvement and Engagement Group, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK.
Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London, UK.
Department of Paediatric Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases Systemic Autoimmunity Branch, Bethesda, Maryland, USA.
Department of Rheumatology, Monash University, Clayton, Victoria, Australia.
Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Direzione Scientifica, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Liguria, Italy.
Department of Pediatric Rheumatology, Botucatu Medical School, Sao Paulo University Faculty of Medicine, Sao Paulo, Brazil.
Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK.
Department of Pediatric Immunology, Rheumatology and Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands.
Department of Paediatric Rheumatology, University of Cape Town, Rondebosch, Western Cape, South Africa.
Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, London, UK.
Abstract summary
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.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.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.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.
Authors & Co-authors:
Smith Eve Mary Dorothy EMD
Aggarwal Amita A
Ainsworth Jenny J
Al-Abadi Eslam E
Avcin Tadej T
Bortey Lynette L
Burnham Jon J
Ciurtin Coziana C
Hedrich Christian M CM
Kamphuis Sylvia S
Levy Deborah M DM
Lewandowski Laura B LB
Maxwell Naomi N
Morand Eric F EF
Ozen Seza S
Pain Clare E CE
Ravelli Angelo A
Saad Magalhaes Claudia C
Pilkington Clarissa A CA
Schonenberg-Meinema Dieneke D
Scott Christiaan C
Tullus Kjell K
Beresford Michael William MW
Study Outcome
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