Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis

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, Sanjay Kalra, Susanna Kullberg, Huiping Li, Elyse E. Lower, Lisa A. Maier, Mehdi MirsaeidiJoachim Müller-Quernheim, Eva M. Carmona Porquera, Lobelia Samavati, Dominique Valeyre, Mary Beth Scholand

Research output: Contribution to journalArticle

3 Scopus citations

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.

Original languageEnglish (US)
Article number190146
JournalEuropean Respiratory Review
Volume29
Issue number155
DOIs
StatePublished - Mar 2020

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Rahaghi, F. F., Baughman, R. P., Saketkoo, L. A., Sweiss, N. J., Barney, J. B., Birring, S. S., Costabel, U., Crouser, E. D., Drent, M., Gerke, A. K., Grutters, J. C., Hamzeh, N. Y., Huizar, I., James, W. E., Kalra, S., Kullberg, S., Li, H., Lower, E. E., Maier, L. A., ... Scholand, M. B. (2020). Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis. European Respiratory Review, 29(155), [190146]. https://doi.org/10.1183/16000617.0146-2019