Doria A, Gatto M, Iaccarino L, Punzi L
Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
Lupus. 2015 Apr;24(4-5):507-15. doi: 10.1177/0961203314559087.
Treat-to-target is a therapeutic strategy aimed at improving disease outcome through the achievement of shared treatment goals, which has dramatically ameliorated the prognosis of widespread disorders, such as hypertension or diabetes. Conversely, efforts to delineate treat-to-target in systemic lupus erythematosus (SLE) have failed in pinpointing common goals and treatment strategies, probably because of disease heterogeneity and lack of measurable biomarkers predicting disease course and ensuring a safe treatment tapering during quiescence. Given the detrimental effects of persistent disease activity and protracted corticosteroid therapy on patients' outcome in lupus, disease remission should be pursued whenever possible. Fortunately, clinical remission is currently realistic for a greater number of patients than it was in the past, yet tight monitoring is required in order for patients to benefit from disease- and corticosteroid-free intervals, while minimizing the risk of disease flares. In everyday practice, patients should be brought to the lowest level of disease activity ensuring a significant benefit over a persistently active disease, being either clinical remission or low disease activity.
达标治疗是一种治疗策略，旨在通过实现共同的治疗目标来改善疾病结局，这已显著改善了高血压或糖尿病等广泛疾病的预后。相反，在系统性红斑狼疮（SLE）中界定达标治疗的努力未能确定共同目标和治疗策略，这可能是由于疾病的异质性以及缺乏可预测疾病进程并确保在病情缓解期安全减药的可测量生物标志物。鉴于持续性疾病活动和长期使用皮质类固醇治疗对狼疮患者结局的有害影响，应尽可能追求疾病缓解。幸运的是，目前对于更多患者来说，实现临床缓解比过去更现实，但为了让患者从无疾病和无皮质类固醇的间歇期中获益，同时将疾病复发风险降至最低，仍需要严密监测。在日常实践中，应将患者的疾病活动度降至最低水平，确保相对于持续活动的疾病有显著益处，无论是临床缓解还是低疾病活动度。
