Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis.

Abstract

Pulmonary sarcoidosis presents substantial management challenges, with limited evidence on effective therapies and phenotypes. In the absence of definitive evidence, expert consensus can supply clinically useful guidance in medicine. An international panel of 26 experts participated in a Delphi process to identify consensus on pharmacological management in sarcoidosis with the development of preliminary recommendations.The modified Delphi process used three rounds. The first round focused on qualitative data collection with open-ended questions to ensure comprehensive inclusion of expert concepts. Rounds 2 and 3 applied quantitative assessments using an 11-point Likert scale to identify consensus.Key consensus points included glucocorticoids as initial therapy for most patients, with non-biologics (immunomodulators), usually methotrexate, considered in severe or extrapulmonary disease requiring prolonged treatment, or as a steroid-sparing intervention in cases with high risk of steroid toxicity. Biologic therapies might be considered as additive therapy if non-biologics are insufficiently effective or are not tolerated with initial biologic therapy, usually with a tumour necrosis factor-α inhibitor, typically infliximab.The Delphi methodology provided a platform to gain potentially valuable insight and interim guidance while awaiting evidenced-based contributions.

• Authors: Franck F Rahaghi, Robert P Baughman, Lesley Ann Saketkoo, Nadera J Sweiss, Joseph B Barney, Surinder S Birring, Ulrich Costabel, Elliott D Crouser, Marjolein Drent, Alicia K Gerke, Jan C Grutters, Nabeel Y Hamzeh, Isham Huizar, W Ennis James 4th, Sanjay Kalra, Susanna Kullberg, Huiping Li, Elyse E Lower, Lisa A Maier, Mehdi Mirsaeidi, Joachim Müller-Quernheim, Eva M Carmona Porquera, Lobelia Samavati, Dominique Valeyre, Mary Beth Scholand
• Journal: European respiratory review : an official journal of the European Respiratory Society (Eur Respir Rev) Vol. 29 Issue 155 (Mar 31 2020) ISSN: 1600-0617 [Electronic] England
• PMID: 32198218 (Publication Type: Journal Article, Review)
• Copyright: Copyright ©ERS 2020.

Chemical References

• Adrenal Cortex Hormones
• Biological Products
• Immunologic Factors

Topics

• Adrenal Cortex Hormones (adverse effects, therapeutic use)
• Algorithms
• Biological Products (adverse effects, therapeutic use)
• Clinical Decision-Making
• Consensus
• Decision Support Techniques
• Delphi Technique
• Humans
• Immunologic Factors (adverse effects, therapeutic use)
• Lung (drug effects, physiopathology)
• Sarcoidosis, Pulmonary (diagnosis, drug therapy, physiopathology)
• Severity of Illness Index