Background: The current "treat-to-target (T2T)" strategic concept has been applied to systemic lupus erythematosus (SLE), stating "lupus maintenance treatment should aim for the lowest glucocorticoid (GC) dosage, and if possible, GCs should be withdrawn completely". We have already reported the successful trade-off between GCs and immunosuppressive agents (ISA) in the prevention of SLE flare. Objectives: We aimed at the retrospective evaluation of current SLE treatment status by focusing on the maintenance dose of GCs and the use of ISA as well as the rate of GC-free patients. Methods: We enrolled 121 patients with SLE patients who was visiting our medical center.All the patients met the American College of Rheumatology (ACR) 1997 or 2012 revised criteria for SLE classification and were followed-up for ≥ 6 months after diagnosis. We evaluated patient backgrounds, SLE disease activity index (SLEDAI) score, the dose of GC, and the use of ISA or biologics from the medical records. Results: Currently, 94% of patients achieved GC dosage of 5 mg/day (prednisolone equivalent) or less and the median GC dosage was 2 mg/day. In addition, 48 (40%) patients were successfully managed with hydroxychloroquine (HCQ) and/or ISA only (including never- and ex-users of GCs). The users of HCQ, ISA, and biologics were 63%, 68% and 7%. respectively. Among ISA, mycophenolate mofetil (38%) and tacrolimus (35%) were commonly used, including their combined use (16%). GC-free patients achieved the median SLEDAI of 1 despite the median SLEDAI of 10 at the first presentation and the median disease duration of 10.5 years, which were comparable with the remaining patients. Conclusion: The T2T strategy for GC dose is applicable for almost all the patients with SLE, and GC-free management is becoming a realistic treatment goal with the aggressive use of HCQ, ISA, and biologics. REFERENCES: [1] Nat Rev Rheumatol. 2022 Mar;18(3):146-157. [2] Intern Med. 2022;61(21):3189-3196. Acknowledgements: NIL. Disclosure of Interests: None declared.
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