TY - JOUR
T1 - A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease
AU - Cartlidge, Manjit K.
AU - Brown, Kevin K.
AU - Chaudhuri, Nazia
AU - Corte, Tamera J.
AU - Dieudé, Phillipe
AU - John, Levin
AU - Kelly, Clive
AU - Khanna, Dinesh
AU - Nicol, Lisa
AU - McRorie, Euan
AU - Stewart, Gareth
AU - Walsh, Simon L.F.
AU - Wijsenbeek, Marlies
AU - Hirani, Nik
AU - PASSWRD participants
AU - Nunes, Hilario
AU - Assaya, Deborah
AU - Sehga, Sameep
AU - Stebbings, Simon M.
AU - Robles-Perez, Alejandro
AU - Crawshaw, Anjali
AU - Gudmundsson, Gunnar
AU - Blum, H. C.
AU - Crestani, Bruno
AU - Confalonieri, Paola
AU - Sebastiani, Marco
AU - Gabrielli, Armando
AU - Balestro, Elisabetta
AU - Kiyan, Esen
AU - Morovic-Vergles, Jadranka
AU - Berlengiero, Virginia
AU - Rivera-Ortega, Pilar
AU - Matsuda, Toshiaki
AU - Bernardino, Vera
AU - Saunders, Peter
AU - Marovic, Kristina Frketic
AU - Sulli, Alberto
AU - van der Lee, Ivo
AU - Manfredi, Andreina
AU - Al-farttoosi, Abdulla
AU - Campochiaro, Corrado
AU - Nossent, E. J.
AU - Iudici, Michele
AU - Ryerson, Christopher J.
AU - Grazzini, Silvia
AU - Derrett-Smith, Emma
AU - Parfrey, Helen
AU - MdC, Venero
AU - Waseda, Yuko
AU - Reza Beiga, Davide Mohammed
AU - Dhasmana, Devesh J.
PY - 2024/12/1
Y1 - 2024/12/1
N2 - BackgroundDrugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors.AimTo determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions.MethodsA modified international 3-tier Delphi exercise was performed. Tier 1 determined patient and drug variables that physicians perceive to be risk factors. Tier 2 determined degree of risk associated with the Tier-1 derived variables. Tier 3 aimed to internally validate and stratify exemplar cases into risk categories.Results134 pulmonologists and 49 rheumatologists responded to Tier 1;157 physicians completed all tiers. Perceived risk factors included: drug type; history of previous pneumotoxicity; age; smoking; underlying rheumatic disease type and activity; renal function; pulmonary hypertension; left ventricular failure;presence, nature, severity and progression of pre-existing interstitial lung disease. Tier 2 data stratified these variables into risk profiles e.g. never versus current smoking was perceived as low and high risk respectively. An example of perceived high risk resulting from Tier 3 is a 75-year-old current smoker with high-activity rheumatoid arthritis (RA) with severe, progressive ILD being started on methotrexate. A perceived low risk is a 75-year-old currentsmoker with moderate-activity RA and emphysema with no cardiac or renal disease and no pre-existing ILD being started on rituximab. A risk prediction scoring tool is being developed to be used in validation studies.ConclusionThis modified Delphi exercise defined and stratified the perceived risk factors for developing pneumotoxicity. Age, current smoking, high underlying rheumatological disease activity, HRCT definite UIP and honeycombing, severity and progression of pre-existing ILD were perceived to be the highest risk-factors.
AB - BackgroundDrugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors.AimTo determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions.MethodsA modified international 3-tier Delphi exercise was performed. Tier 1 determined patient and drug variables that physicians perceive to be risk factors. Tier 2 determined degree of risk associated with the Tier-1 derived variables. Tier 3 aimed to internally validate and stratify exemplar cases into risk categories.Results134 pulmonologists and 49 rheumatologists responded to Tier 1;157 physicians completed all tiers. Perceived risk factors included: drug type; history of previous pneumotoxicity; age; smoking; underlying rheumatic disease type and activity; renal function; pulmonary hypertension; left ventricular failure;presence, nature, severity and progression of pre-existing interstitial lung disease. Tier 2 data stratified these variables into risk profiles e.g. never versus current smoking was perceived as low and high risk respectively. An example of perceived high risk resulting from Tier 3 is a 75-year-old current smoker with high-activity rheumatoid arthritis (RA) with severe, progressive ILD being started on methotrexate. A perceived low risk is a 75-year-old currentsmoker with moderate-activity RA and emphysema with no cardiac or renal disease and no pre-existing ILD being started on rituximab. A risk prediction scoring tool is being developed to be used in validation studies.ConclusionThis modified Delphi exercise defined and stratified the perceived risk factors for developing pneumotoxicity. Age, current smoking, high underlying rheumatological disease activity, HRCT definite UIP and honeycombing, severity and progression of pre-existing ILD were perceived to be the highest risk-factors.
KW - Drug-induced interstitial lung disease
KW - Drug-induced pneumotoxicity
KW - Interstitial lung disease
KW - Pneumotoxicity
KW - Rheumatological drugs
U2 - 10.1186/s12890-024-03287-0
DO - 10.1186/s12890-024-03287-0
M3 - Article
C2 - 39482644
AN - SCOPUS:85208290842
SN - 1471-2466
VL - 24
JO - BMC Pulmonary Medicine
JF - BMC Pulmonary Medicine
IS - 1
M1 - 547
ER -