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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.
A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease
Cartlidge, Manjit K.;Brown, Kevin K.;Chaudhuri, Nazia;Corte, Tamera J.;Dieudé, Phillipe;John, Levin;Kelly, Clive;Khanna, Dinesh;McRorie, Euan;Nicol, Lisa;Stewart, Gareth;Walsh, Simon L. F.;Wijsenbeek, Marlies;Hirani, Nik;null, null;Chalmers, George W;Golla, Janardhana;Hyldgaard, Charlotte;Chaigne, Benjamin;López Miguel, Patricia;Bendstrup, Elisabeth;Carbone, Roberto G;Selva-O'Callaghan, Albert;Chaudhury, Nazia;Selvi, Enrico;Russell, Tonya;Ferreira, Pedro;Mukherjee, Suranjan;Kah-Lai Leong, Carrie;Alfaro, Tiago;Carreira, Patricia E;Dhasmana, Devesh J;Cameli, Paolo;Wuyts, Wim A;Bennett, David;Novelli, Luca;Patel, Divya C;Fahim, Ahmed;Wilsher, Margaret L;Shifren, Adrian;Padilla, Maria L.;Muller, Carolina;Avdeev, Sergey;Dzhus, Marta;Papanikolaou, Ilias C;Tanino, Yoshinori;Fretheim, Harvard;Balbir-Gurman, Alexandra;Vicens-Zygmunt, Vanesa;Jones, Mark G;Perch, Michael;Brito de Araujo, Daniel;Conticini, Edoardo;Keshavan, V;Izumi, Shinyu;Kalluri, Meena;Hajari Case, Amy;Turner, Alice M;Baresic, Marko;Koduri, Gouri M;Amaral, Alexandre Franco;Eiger, Glenn;Salinas, Mauricio;Nunes, Mario Sergio;Chai, Gin Tsen;Scarlata, Simone;Radzikowska, Elżbieta;Maher, Toby M;Benucci, Maurizio;Myall, Katherine J;Davidsen, Jesper Rømhild;Launay, David;Culver, Dr Emma L;Castro, Horacio Matias;Devi, HJ Gayathri;Naclerio, Caterina;Walker, Ulrich A.;Chua, Felix;Garcia Gonzalez, Estrella;Montoya, Sandra Fabiana;Carty, Sara Madelaine;Judge, Eoin P;O'Beirne, Sarah L;Johannson, Kerri A;Camus, Philippe;Bilaceroglu, Semra;Gardiner, Philip V;Nicol, Lisa M;Garcia Martos, Álvaro;Castillo, Diego;Lipchik, Randolph J;Drakopanagiotakis, Fotio;Vikse, Jens;Ramirez, Maria Teresa Rio;Antin-Ozerkis, Danielle;Grainger, Rebecca;Stewart, Gareth A;Borie, Raphael;Agrawal, Aditya;Ceribelli, Angela;Guillen, Alfredo;Saiton, Shigeki;Tomii, Keisuke;Luckhardt, Tracy;Highland, Kristin B;Gheorghiu, Ana Maria;Kolb, Martin;Cobilinschi, Claudia;Jones, Richard Mathew;Campainha, Sergio;Rosato, Edoardo;Foti, Rosario;Juge, Pierre-Antoine;Patil, Shital;Busaid, Nasser Al;Rednic, Simona;Garzanova, Liudmila;Solomon, Joshua J;Kalyoncu, Ali Fuat;Ross, Alessandra Della;Perkovic, Dijana;Kabasakal, Yasemin;Mogulkoc, Nesrin;Low, Su-Ying;Godoy, null;Spencer, Lisa G;Delobbe, Alain;Toma, Claudia Lucia;Hysa, Elvis;Reza Beiga, Davide Mohammed;Waseda, Yuko;MdC, Venero;Parfrey, Helen;Derrett-Smith, Emma;Grazzini, Silvia;Ryerson, Christopher J;Iudici, Michele;Nossent, E J;Campochiaro, Corrado;Al-farttoosi, Abdulla;Manfredi, Andreina;Robles-Perez, Alejandro;van der Lee, Ivo;Hirani, Nik;Sulli, Alberto;Marovic, Kristina Frketic;Saunders, Peter;Bernardino, Vera;Matsuda, Toshiaki;Rivera-Ortega, Pilar;Berlengiero, Virginia;Morovic-Vergles, Jadranka;Kiyan, Esen;Balestro, Elisabetta;Gabrielli, Armando;Sebastiani, Marco;Confalonieri, Paola;Crestani, Bruno;Blum, HC;Gudmundsson, Gunnar;Crawshaw, Anjali;Robles-Perez, Alejandro;Stebbings, Simon M;Sehga, Sameep;Assaya, Deborah;Nunes, Hilario
2024-01-01
Abstract
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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/3007217
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
