The Treat-to-Target (T2T) principle has been advocated in a number of inflammatory
and non-inflammatory medical illnesses. Tight control of disease activity has been shown to improve
the outcome of rheumatoid arthritis and psoriatic arthritis as compared to the conventional
approach. However, whether T2T can be applied to patients with lupus nephritis is still under
emerging discussion. Treatment of lupus nephritis should target at inducing and maintaining remission
of the kidney inflammation so as to preserve renal function and improve survival in the longterm.
However, there is no universal agreement on the definition of remission or low disease activity
state of nephritis, as well as the time points for switching of therapies. Moreover, despite the
availability of objective parameters for monitoring such as proteinuria and urinary sediments, differentiation
between ongoing activity and damage in some patients with persistent urinary abnormalities
remains difficult without a renal biopsy. A large number of serum and urinary biomarkers
have been tested in lupus nephritis but none of them have been validated for routine clinical use. In
real life practice, therapeutic options for lupus nephritis are limited. As patients with lupus nephritis
are more prone to infective complications, tight disease control with aggressive immunosuppressive
therapies may have safety concern. Not until the feasibility, efficacy, safety and cost-effectiveness
of T2T in lupus nephritis is confirmed by comparative trials, this approach should not be routinely
recommended with the current treatment armamentarium and monitoring regimes.
Keywords: Lupus nephritis, treat-to-target, outcome, immunosuppressive, biomarkers, clinical practice.
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