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. 2024 Oct 31;24(1):547.
doi: 10.1186/s12890-024-03287-0.

A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease

Manjit K Cartlidge  1 , Kevin K Brown  2 , Nazia Chaudhuri  3 , Tamera J Corte  4 , Phillipe Dieudé  5 , Levin John  6 , Clive Kelly  7 , Dinesh Khanna  8 , Euan McRorie  9 , Lisa Nicol  10 , Gareth Stewart  9   11 , Simon L F Walsh  12 , Marlies Wijsenbeek  13 , Nik Hirani  10   11 ; PASSWRD participants
Collaborators, Affiliations

A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease

Manjit K Cartlidge et al. BMC Pulm Med. .

Abstract

Background: Drugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors.

Aim: To determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions.

Methods: A 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.

Results: 134 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.

Conclusion: This 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.

Keywords: Drug-induced interstitial lung disease; Drug-induced pneumotoxicity; Interstitial lung disease; Pneumotoxicity; Rheumatological drugs.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Consort diagram of respondents to each stage of the eDelphi process
Fig. 2
Fig. 2
Risk of pneumotoxicity with commonly prescribed rheumatological drugs according to rheumatologists and pulmonologists. A = Disease modifying anti-rheumatic drugs, B = Anti-TNF, C = Anti-IL1, D = Anti-IL6, E = T-Cell modulator, F = Anti-IL12/23, G = B-Cell modulator, H = Anti-IL17, I = JAKSTAT inihibitors. P values calculated for those reaching the 30% threshold (dotted line): * < 0.05 ** < 0.01, *** < 0.001
See this image and copyright information in PMC

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