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Clinical Rheumatology

Open Access 30-08-2024 | Systemic Lupus Erythematosus | ORIGINAL ARTICLE

Active implementation of low disease activity state as a treatment endpoint in childhood-onset systemic lupus erythematosus in routine practice is both feasible and associated with better outcomes

Authors: Ruby Gotch, Yumna Ahmed, Robert Wilson, Ellie Hawkins, Coziana Ciurtin

Published in: Clinical Rheumatology

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Abstract

Introduction

Treat-to-target (T2T) strategies aim to facilitate tight disease control to improve outcomes. No previous studies evaluated prospectively the feasibility and impact of the T2T strategy in routine practice in childhood-onset SLE (cSLE).

Methods

Adolescents and young adults (AYA) with cSLE were recruited for T2T implementation from a large tertiary centre over a period of 6 months and followed up at least twice over a prospective period of 12 months.

Results

During Oct 2022–April 2023, 135/162 (83.3%) AYA with cSLE had disease scores evaluated at their routine appointment to enable inclusion in the study, and 122/135 (91.2%) had their disease assessed, and a suitable treatment target agreed and documented at each routine clinical appointment over the 12 months prospective follow-up. T2T strategy led to improved disease control at 12 months: more AYA with cSLE achieved clinical remission off steroids (4.1% vs. 10.7%, P = 0.048), or minimum childhood-lupus low disease activity (cLLDAS) (81.9% vs. 91.8%, P = 0.022). Achieving minimum cLLDAS for longer than 3 months was associated with reduced damage accrual (HR = 1.7; 95%CI = 1.1–2.5; P < 0.0001) at 12 months.

Conclusion

T2T strategy implementation was achievable and associated with improved cSLE control. Spending at least 3/12 months in cLLDAS led to less damage accumulation.
Key Points
• This is the first large prospective study in AYA with cSLE to evaluate the impact of active T2T implementation in routine practice.
• T2T strategies were feasible to implement in 122/135 (91.2%) AYA with cSLE in routine practice.
• The T2T approach was associated with improved disease control and decreased damage accrual at 12 months.
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Metadata
Title
Active implementation of low disease activity state as a treatment endpoint in childhood-onset systemic lupus erythematosus in routine practice is both feasible and associated with better outcomes
Authors
Ruby Gotch
Yumna Ahmed
Robert Wilson
Ellie Hawkins
Coziana Ciurtin
Publication date
30-08-2024
Publisher
Springer International Publishing
Published in
Clinical Rheumatology
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-024-07101-4

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