Treat to target, remission and low disease activity in SLE

Despite improvements in survival, outcomes of contemporary treatment of systemic lupus erythematosus (SLE) are unacceptable. Unlike in many diseases, treat-to-target (T2T) approaches have not been adopted in SLE, owing to a lack of validated targets to treat towards. Therefore, it is a key goal to validate target state definitions such as low disease activity and remission, and test their implementation in clinical practice and clinical trials. In this article, we review recent advances in T2T approaches in SLE, and emerging evidence-based consensus on definitions of remission and low disease activity that are needed to underpin such approaches. We conclude that, while more work is needed, much has been achieved and at least for low disease activity the lupus low disease activity state definition appears to have utility and validity for the study of SLE. Application to routine clinical care awaits validation of improved outcomes from T2T studies based on these targets.