RT Journal Article
SR Electronic
T1 Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis
JF European Respiratory Review
JO EUROPEAN RESPIRATORY REVIEW
FD European Respiratory Society
SP 190146
DO 10.1183/16000617.0146-2019
VO 29
IS 155
A1 Franck F. Rahaghi
A1 Robert P. Baughman
A1 Lesley Ann Saketkoo
A1 Nadera J. Sweiss
A1 Joseph B. Barney
A1 Surinder S. Birring
A1 Ulrich Costabel
A1 Elliott D. Crouser
A1 Marjolein Drent
A1 Alicia K. Gerke
A1 Jan C. Grutters
A1 Nabeel Y. Hamzeh
A1 Isham Huizar
A1 W. Ennis James IV
A1 Sanjay Kalra
A1 Susanna Kullberg
A1 Huiping Li
A1 Elyse E. Lower
A1 Lisa A. Maier
A1 Mehdi Mirsaeidi
A1 Joachim Müller-Quernheim
A1 Eva M. Carmona Porquera
A1 Lobelia Samavati
A1 Dominique Valeyre
A1 Mary Beth Scholand
YR 2020
UL http://err.ersjournals.com/content/29/155/190146.abstract
AB 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.Expert consensus recommendations for a pulmonary sarcoidosis treatment algorithm from a modified Delphi process include corticosteroids as initial therapy, immunomodulators for steroid-sparing or severe disease, and biologics for very severe disease http://bit.ly/2SmP3uG