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Review
. 2020 Mar 20;29(155):190147.
doi: 10.1183/16000617.0147-2019. Print 2020 Mar 31.

Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study

Franck F Rahaghi  1 , Nadera J Sweiss  2 , Lesley Ann Saketkoo  3 , Mary Beth Scholand  4 , Joseph B Barney  5 , Alicia K Gerke  6 , Elyse E Lower  7 , Mehdi Mirsaeidi  8 , Lanier O'Hare  5 , Mark J Rumbak  9 , Lobelia Samavati  10 , Robert P Baughman  11
Affiliations
Review

Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study

Franck F Rahaghi et al. Eur Respir Rev. .

Abstract

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines.We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale.Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe.In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis.

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Conflict of interest statement

Conflict of interest: F.F. Rahaghi reports grants and consulting fees from Mallinckrodt, during the conduct of the study. Conflict of interest: N.J. Sweiss has nothing to disclose. Conflict of interest: L.A. Saketkoo has nothing to declare. Conflict of interest: M.B. Scholand reports other from Boehringer Ingelheim, Genentech, Fibrogen and Global Blood Therapeutics, outside the submitted work. In addition, M.B. Scholand has a patent Apparatus, Compositions and Methods for Assessment of Chronic Obstructive Pulmonary Disease Progression among Rapid and Slow Decline Conditions issued. Conflict of interest: J.B. Barney has nothing to disclose. Conflict of interest: A.K. Gerke has nothing to disclose. Conflict of interest: E.E. Lower has nothing to disclose. Conflict of interest: M. Mirsaeidi reports grants and personal fees from Mallinckrodt, outside the submitted work. Conflict of interest: L. O'Hare has nothing to disclose. Conflict of interest: M.J. Rumbak has nothing to disclose. Conflict of interest: L. Samavati has participated in a Questcor Advisory Board Meeting in 2014 and received $6500 compensation. Conflict of interest: R.P. Baughman reports grants and personal fees from Malllinckrodt, Novartis and Celgene, grants from Gilead, Genentech and Bayer, personal fees from West Pharmaceutical, during the conduct of the study.

Figures

FIGURE 1
FIGURE 1
The Delphi process used in the study.
FIGURE 2
FIGURE 2
Panellists' reasons for initiating repository corticotrophin injection (RCI) in patients with pulmonary sarcoidosis. #: to steroids, antimetabolites or biologics; : after steroids; +: after steroids and antimetabolites; §: after steroids and biologics; ƒ: after steroids, antimetabolites and biologics.
FIGURE 3
FIGURE 3
Consensus recommendations for repository corticotrophin injection (RCI) dosing and concomitant steroid use.
FIGURE 4
FIGURE 4
Consensus recommendations for non-pharmacological and pharmacological management of new or worsening adverse events in patients receiving repository corticotrophin injection as therapy for pulmonary sarcoidosis. Bold indicates non-pharmacological interventions. PCP: primary care physician. #: no pharmacological interventions reached consensus for these adverse events; : glucose intolerance or worsening of glucose control.
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References

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