AI Article Synopsis
- An international Task Force of specialists convened to develop a 'treat-to-target' (T2T) approach for improving care in childhood-onset systemic lupus erythematosus (cSLE) through expert consensus and systematic literature review.* -
- The Task Force established four key principles and fourteen important considerations emphasizing shared decision-making with patients and caregivers, aiming for full remission, prevention of flare-ups, and addressing health-related quality of life factors.* -
- This consensus framework for T2T in cSLE is expected to guide future strategies and research, gaining support from the Paediatric Rheumatology European Society.*
Article 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.
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.
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.
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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10314055 | PMC |
| http://dx.doi.org/10.1136/ard-2022-223328 | DOI Listing |
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