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 Rahaghi, Franck F. A1 Baughman, Robert P. A1 Saketkoo, Lesley Ann A1 Sweiss, Nadera J. A1 Barney, Joseph B. A1 Birring, Surinder S. A1 Costabel, Ulrich A1 Crouser, Elliott D. A1 Drent, Marjolein A1 Gerke, Alicia K. A1 Grutters, Jan C. A1 Hamzeh, Nabeel Y. A1 Huizar, Isham A1 Ennis James, W. A1 Kalra, Sanjay A1 Kullberg, Susanna A1 Li, Huiping A1 Lower, Elyse E. A1 Maier, Lisa A. A1 Mirsaeidi, Mehdi A1 Müller-Quernheim, Joachim A1 Carmona Porquera, Eva M. A1 Samavati, Lobelia A1 Valeyre, Dominique A1 Scholand, Mary Beth YR 2020 UL https://publications.ersnet.org//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