Abstract
Treat to target (T2T) strategies have proved to be useful in several chronic disorders, including Rheumatoid Arthritis. In systemic lupus erythematosus (SLE), T2T strategy has been proposed in order to control disease activity, improve health-related quality of life, and reduce morbidity and mortality. Remission would be the main target, but a low disease activity state (LDAS) could be an acceptable alternative. However, due to SLE protean manifestations, the operational definitions of both remission and LDAS are still in progress. The definitions of these targets, remission and LDAS, should include a validated disease activity index, the treatments allowed, and the minimum length of time the target should be maintained. Furthermore, achieving these targets should result in better disease outcomes such as reducing damage accrual. This review addresses the current state regarding these possible targets in SLE and the impact of achieving them in intermediate and long-term outcomes of this disease.
Similar content being viewed by others
References
Riddle MC, Rosenstock J, Gerich J (2003) The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care 26(11):3080–3086
Garber AJ (2014) Treat-to-target trials: uses, interpretation and review of concepts. Diabetes Obes Metab 16(3):193–205
Solomon DH, Bitton A, Katz JN, Radner H, Brown EM, Fraenkel L (2014) Review: treat to target in rheumatoid arthritis: fact, fiction, or hypothesis? Arthritis Rheum 66(4):775–782
Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM, Zwinderman AH, Ronday HK, Han KH, Westedt ML, Gerards AH, van Groenendael JH, Lems WF, van Krugten MV, Breedveld FC, Dijkmans BA (2005) Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum 52(11):3381–3390
Yurkovich M, Vostretsova K, Chen W, Avina-Zubieta JA (2014) Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Care Res 66(4):608–616
Mak A, Isenberg DA, Lau CS (2013) Global trends, potential mechanisms and early detection of organ damage in SLE. Nat Rev Rheumatol 9(5):301–310
van Vollenhoven RF, Mosca M, Bertsias G, Isenberg D, Kuhn A, Lerstrom K, Aringer M, Bootsma H, Boumpas D, Bruce IN, Cervera R, Clarke A, Costedoat-Chalumeau N, Czirjak L, Derksen R, Dorner T, Gordon C, Graninger W, Houssiau F, Inanc M, Jacobsen S, Jayne D, Jedryka-Goral A, Levitsky A, Levy R, Mariette X, Morand E, Navarra S, Neumann I, Rahman A, Rovensky J, Smolen J, Vasconcelos C, Voskuyl A, Voss A, Zakharova H, Zoma A, Schneider M (2014) Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis 73(6):958–967
Franklyn K, Hoi A, Nikpour M, Morand EF (2014) The need to define treatment goals for systemic lupus erythematosus. Nat Rev Rheumatol 10(9):567–571
Tozman EC, Urowitz MB, Gladman DD (1982) Prolonged complete remission in previously severe SLE. Ann Rheum Dis 41(1):39–40
Drenkard C, Villa AR, Garcia-Padilla C, Perez-Vazquez ME, Alarcon-Segovia D (1996) Remission of systematic lupus erythematosus. Medicine (Baltimore) 75(2):88–98
Urowitz MB, Feletar M, Bruce IN, Ibanez D, Gladman DD (2005) Prolonged remission in systemic lupus erythematosus. J Rheumatol 32(8):1467–1472
Zen M, Iaccarino L, Gatto M, Bettio S, Nalotto L, Ghirardello A, Punzi L, Doria A (2015) Prolonged remission in Caucasian patients with SLE: prevalence and outcomes. Ann Rheum Dis 74(12):2117–2122
Formiga F, Moga I, Pac M, Mitjavila F, Rivera A, Pujol R (1999) High disease activity at baseline does not prevent a remission in patients with systemic lupus erythematosus. Rheumatology (Oxford) 38(8):724–727
van Vollenhoven R, Aranow C, Bertsias G, Bonfá E, Cervera R, Costedoat-Chalumeau N, Dörner T, Houssiau F, Lerstrom K, Morand E (2015) OP0092 remission in sle: consensus findings from a large international panel on definitions of remission in SLE (DORIS). Ann Rheum Dis 74(Suppl 2):103–103
Ko K, Levine AB, Griffin R, Dvorkina O, Sheikh S, Yazdany J, Furie R, Aranow C (2015) Baseline predictors of remission and low disease activity using recently defined international criteria in a multi-center lupus registry cohort (abstract). Arthritis Rheumatol 67(suppl 10). http://acrabstracts.org/abstract/baseline-predictors-of-remission-and-low-disease-activity-using-recently-defined-international-criteria-in-a-multi-center-lupus-registry-cohort/. Accessed 31 May 2016
Fischer T, Magder LS, Petri M (2015 Application of new EULAR definitions of remission in SLE: durable 1-year remission is rare (abstract). Arthritis Rheumatol 67(suppl 10). http://acrabstracts.org/abstract/application-of-new-eular-definitions-of-remission-in-sle-durable-1-year-remission-is-rare/. Accessed 31 May 2010
Wilhelm TR, Petri M, Magder L (2016) Application of new definitions of remission in SLE: durable remission is rare. Ann Rheum Dis 75(Suppl 2):317
Medina-Quinones CV, Ramos-Merino L, Ruiz-Sada P, Isenberg D (2016) Analysis of complete remission in systemic lupus erythematosus patients over a 32-year period. Arthritis Care Res 68(7):981–987
Bootsma H, Spronk P, Derksen R, de Boer G, Wolters-Dicke H, Hermans J, Limburg P, Gmelig-Meyling F, Kater L, Kallenberg C (1995) Prevention of relapses in systemic lupus erythematosus. Lancet 345(8965):1595–1599
Tseng CE, Buyon JP, Kim M, Belmont HM, Mackay M, Diamond B, Marder G, Rosenthal P, Haines K, Ilie V, Abramson SB (2006) The effect of moderate-dose corticosteroids in preventing severe flares in patients with serologically active, but clinically stable, systemic lupus erythematosus: findings of a prospective, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 54(11):3623–3632
Zen M, Bassi N, Nalotto L, Canova M, Bettio S, Gatto M, Ghirardello A, Iaccarino L, Punzi L, Doria A (2012) Disease activity patterns in a monocentric cohort of SLE patients: a seven-year follow-up study. Clin Exp Rheumatol 30(6):856–863
Franklyn K, Lau CS, Navarra SV, Louthrenoo W, Lateef A, Hamijoyo L, Wahono CS, Chen SL, Jin O, Morton S, Hoi A, Huq M, Nikpour M, Morand EF (2015) Definition and initial validation of a lupus low disease activity state (LLDAS). Ann Rheum Dis. doi:10.1136/annrheumdis-2015-207726
Steiman AJ, Gladman DD, Ibanez D, Urowitz MB (2012) Outcomes in patients with systemic lupus erythematosus with and without a prolonged serologically active clinically quiescent period. Arthritis Care Res 64(4):511–518
Steiman AJ, Urowitz MB, Ibanez D, Papneja A, Gladman DD (2014) Prolonged clinical remission in patients with systemic lupus erythematosus. J Rheumatol 41(9):1808–1816
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
None.
Rights and permissions
About this article
Cite this article
Ugarte-Gil, M.F., Burgos, P.I. & Alarcón, G.S. Treat to target in systemic lupus erythematosus: a commentary. Clin Rheumatol 35, 1903–1907 (2016). https://doi.org/10.1007/s10067-016-3346-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-016-3346-2