FRAMEWORK FOR IMPLEMENTING TREAT-TO-TARGET IN SYSTEMIC LUPUS ERYTHEMATOSUS ROUTINE CLINICAL CARE: CONSENSUS STATEMENTS FROM AN INTERNATIONAL TASK FORCE.
Notice bibliographique
Résumé
O034 / #681 Topic:AS09 - Emerging Approaches in SLE Management ABSTRACT CONCURRENT SESSION 05: EMERGING INSIGHTS ON THE MANAGEMENT OF LUPUS MANIFESTATIONS AND COMORBIDITIES 23-05-2025 1:40 PM - 2:40 PM Background/Purpose The adoption of Treat-to-Target (T2T) in routine clinical care for systemic lupus erythematosus (SLE) is limited, with evidence showing ongoing overuse of glucocorticoids (GCs) and inadequate disease control in many patients. An international task force convened to address the challenges and identify effective strategies for implementing T2T in adult SLE patients in real-life settings. Methods The T2T task force comprised a multidisciplinary panel of 22 physicians with extensive experience in SLE management and 3 lupus patient research partners. The panel’s geographical distribution included 9 (40.9%) experts from Europe, 4 (16.5%) from Asia-Pacific, 3 (13.6%) from North America, 3 (13.6%) from Latin America, and 3 (13.6%) from Africa. Through a scoping review and online discussions, the panel mapped, identified, and discussed the current limitations and best available options for implementing T2T in SLE. Drawing from these findings, the panel formulated a series of potential framework statements, which were rigorously debated and refined before reaching an agreement through a Delphi consensus process. Results The resulting framework outlines 5 overarching principles and 11 specific statements (Table). The T2T strategy should be implemented as early as possible during the disease course, favored by a shared decision-making approach and by including nonpharmacological measures and telehealth in the process. The importance of achieving remission within a prespecified timeframe is highlighted. At the same time, LLDAS is highlighted as a valuable alternative target when remission cannot be achieved or maintained. The task force suggests time intervals between visits, guided by disease activity status. If remission is not attained within the recommended timeframe, adherence to therapy should be evaluated, and treatment strategies should be optimized accordingly. At each clinical visit, prioritizing the tapering of glucocorticoids is essential, with complete discontinuation considered for patients in sustained remission, ideally by following a slow tapering protocol. Prolonged remission, defined as remission lasting 5 years or longer, opens the possibility of discontinuing immunosuppressants and/or biologics in patients who have successfully discontinued glucocorticoids. Goals, priorities, and areas of investigation for future research endeavors were identified (Figure). Table. Figure. Conclusions Although formal evidence proving the superiority of T2T to conventional SLE management is lacking, the approach has been recommended for over a decade due to its potential to standardize care and improve patient outcomes. This framework represents a practical, consensus-driven tool for implementing T2T in real-world SLE management. It is designed to guide a broad spectrum of healthcare providers, including those beyond the specialized circle of lupus experts, in delivering structured, goal-oriented care to their patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,418 | 0,282 |
| Méta-épidémiologie (sens strict) | 0,004 | 0,003 |
| Méta-épidémiologie (sens large) | 0,004 | 0,010 |
| Bibliométrie | 0,011 | 0,008 |
| Études des sciences et des technologies | 0,011 | 0,008 |
| Communication savante | 0,015 | 0,010 |
| Science ouverte | 0,013 | 0,022 |
| Intégrité de la recherche | 0,016 | 0,022 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».