Advancing treat-to-target in systemic lupus erythematosus Bridging the gaps in patient experience, evidence, and digital innovation

Systemic Lupus Erythematosus (SLE) is a complex, multisystem autoimmune disorder characterized by persistent inflammation, heterogeneous clinical manifestations, and a significant burden on patient quality of life. Despite therapeutic improvements, patients continue to face higher mortality rates and irreversible organ damage compared to the general population. This thesis, titled "Advancing Treat-to-Target in Systemic Lupus Erythematosus: Bridging the gaps in patient experience, evidence, and digital innovation," explores strategies to optimize disease management through the treat-to-target (T2T) framework.
The research is divided into two primary parts:

Part I: Insights into T2T Strategy: This section reviews the current implementation of T2T in SLE, examining the longitudinal relationship between disease activity and patient-physician discordance. It further analyzes trial design factors across 26 phase II and III studies to identify elements associated with success in randomized controlled trials.Part II: Digital Strategies for Implementation: This section focuses on innovation, detailing the development and usability of a web-based eHealth Clinical Decision Support System (CDSS). The thesis concludes with a pilot study evaluating the effectiveness of this digital tool in advancing T2T management in clinical practice.

By addressing gaps in clinical evidence and leveraging digital health technology, this work aims to refine therapeutic decision-making, reduce damage accrual, and ultimately improve the long-term prognosis and experience of patients living with SLE.