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The following is a summary of “A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease,” published in the October 2024 issue of Pulmonology by Cartlidge et al.
The drugs used for treating rheumatic diseases were linked to pneumotoxicity (drug-induced lung disease), but the risk factors involved remained largely unclear.
Researchers conducted a retrospective study to identify expert physician-perceived risk factors for pneumotoxicity in patients with rheumatologic conditions.
They performed a modified international 3-tier Delphi exercise. In Tier 1, patient and drug variables were considered by physicians as risk factors, and in Tier 2 the degree of risk linked to the Tier-1 variables were assessed, and an internal validation and classification of exemplar cases into distinct risk categories were determined.
The results showed that 134 pulmonologists and 49 rheumatologists responded to Tier 1, with 157 physicians completing 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, and presence, nature, severity, and progression of pre-existing interstitial lung disease (ILD). Tier 2 data stratified these variables into risk profiles, e.g., never vs current smoking was perceived as low and high risk, respectively. Tier 3 identified a 75-year-old current smoker with high-activity rheumatoid arthritis (RA) and severe, progressive ILD starting methotrexate as a high-risk example, while a 75-year-old current smoker with moderate-activity RA, emphysema, no cardiac or renal disease, and no pre-existing ILD starting rituximab was considered as low risk. A risk prediction scoring tool is being developed for validation studies.
They concluded the modified Delphi exercise identified and stratified key risk factors for pneumotoxicity, with age, current smoking, high disease activity, HRCT-defined UIP and honeycombing, and the severity and progression of pre-existing ILD being the highest risks.
Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03287-0
