Abstract
Background: Drugs used to treat rheumatological disease may be associated with pneumotoxicity, but little is known about associated risk factors.
Aims: To derive majority (defined as >70%) agreement from expert rheumatologists and pulmonologists on their perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease.
Methods: A modified international Delphi. Tier 1 to determine patient-level and drug specific variables physicians perceive are associated with risk of pneumotoxicity. Tier 2 to stratify the risk associated with the Tier-1 derived variables. Tier 3 to internally validate exemplar cases into risk categories.
Results: 134 pulmonologists and 49 rheumatologists responded to tier 1. 157 completed all tiers. After tier 1 the perceived risk factors included: drug; history of drug-induced pneumotoxicity; age; rheumatological disease type and activity; renal function; presence, nature, severity and progression of pre-existing interstitial lung disease (ILD). Tier 2 data stratified these variables e.g. never v current smoking was perceived as low and high risk respectively. After tier 3 validation an example of a perceived high risk case is a 75yr old smoker with high-activity rheumatoid arthritis (RA) with severe, progressive ILD being started on methotrexate. A perceived low risk case is a 75yr old smoker with moderate-activity RA and emphysema with no cardiac or renal disease and no pre-existing ILD being started on rituximab.
Conclusion: This Delphi exercise has defined and stratified the perceived risk factors for developing drug-induced pneumotoxicity. A derived risk-prediction tool will be used to validate these perceived risk factors in clinical practice.
Aims: To derive majority (defined as >70%) agreement from expert rheumatologists and pulmonologists on their perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease.
Methods: A modified international Delphi. Tier 1 to determine patient-level and drug specific variables physicians perceive are associated with risk of pneumotoxicity. Tier 2 to stratify the risk associated with the Tier-1 derived variables. Tier 3 to internally validate exemplar cases into risk categories.
Results: 134 pulmonologists and 49 rheumatologists responded to tier 1. 157 completed all tiers. After tier 1 the perceived risk factors included: drug; history of drug-induced pneumotoxicity; age; rheumatological disease type and activity; renal function; presence, nature, severity and progression of pre-existing interstitial lung disease (ILD). Tier 2 data stratified these variables e.g. never v current smoking was perceived as low and high risk respectively. After tier 3 validation an example of a perceived high risk case is a 75yr old smoker with high-activity rheumatoid arthritis (RA) with severe, progressive ILD being started on methotrexate. A perceived low risk case is a 75yr old smoker with moderate-activity RA and emphysema with no cardiac or renal disease and no pre-existing ILD being started on rituximab.
Conclusion: This Delphi exercise has defined and stratified the perceived risk factors for developing drug-induced pneumotoxicity. A derived risk-prediction tool will be used to validate these perceived risk factors in clinical practice.
| Original language | English |
|---|---|
| Article number | PA1566 |
| Journal | European Respiratory Journal |
| Volume | 66 |
| Issue number | Suppl 68 |
| DOIs | |
| Publication status | Published online - 30 Oct 2024 |
Bibliographical note
This article was presented at the 2024 ERS Congress, in session “Innovative perspectives on cellular mechanisms in lung diseases”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).